Dislocated nuclear fragments after cataract surgery

Abstract

Posterior nuclear dislocation is a serious complication of cataract surgery, especially when using the phacoemulsification technique. So far, there have been only a few reports concerning the indications and timing of vitrectomy with nuclear removal as well as long-term visual outcome of these eyes. We analysed 23 consecutive patients (follow-up at least 3 months) with intravitreal nuclear remnants after cataract surgery treated with vitrectomy and removal of posteriorly dislocated nuclei. All the eyes had increased intraocular pressure pre-vitrectomy, 63% had corneal oedema, 67% marked uveitis and 26% either retinal tear or detachment. Vitrectomy was performed within 1 week in 70% of eyes. In 14 eyes (61%) the final visual acuity was 20/40 or more. The main reason for poor visual outcome was retinal detachment (9%). These results indicate that with vitrectomy and removal of the nucleus good visual results can be achieved in a large proportion of eyes with posterior dislocation of nuclear remnants.

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery

“…This percentage is apparently lower compared with other published series with 41-82% of cases achieving a final visual acuity of 6/12 or better, regardless of the time interval between cataract and vitreous surgery. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]24 This may be due to a large proportion (31%) of our cases having pre-existing ocular diseases before cataract surgery, with an overall median preoperative visual acuity of 6/90. In the series by Kageyama et al, 5 the median preoperative visual acuity was 6/15 with only 12% of cases had pre-existing ocular comorbidity.…”

“…Kim et al 8 reported that 75% of eight eyes operated on the same day as the cataract surgery had final vision of 6/9 or better, while only 63% of the other 54 eyes operated later had final vision of 6/12 or better. Tommila and Immonen 17 reported that of eyes undergoing vitrectomy immediately after cataract extraction 57% of seven eyes achieved a vision of 6/12 or better, compared with 78% of 16 eyes that were vitrectomised 1-7 days after cataract surgery. Terasaki et al 18 reported that 75% of four eyes operated on the same day as the cataract surgery had final vision of 6/9 or better, compared with 70% of the other 10 eyes operated 2-7 days after cataract surgery.…”

“…This rate of retinal detachment is within the range reported in other studies in which vitrectomy was performed later for retained lens fragment, which ranged from 0 to 21.5%. [6][7][8][9][10][11][12][13][14][15][16][17]19,20,21,24,25 This suggests that early vitrectomy does not prevent the problem of development of retinal detachment. The reattachment rate for retinal detachment after vitrectomy for retained lens fragment is usually favourable, but visual outcomes are often poor due to other comorbidities particularly cystoid macular oedema.…”

“…[6][7][8] Pars plana vitrectomy has been used successfully to retrieve the retained lens fragments in order to minimise the risk of further complications. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Although the optimal timing of pars plana vitrectomy remains controversial, 7,[10][11][12][13][14] histological studies have shown that inflammatory reaction is more severe with longer duration of lens fragments remaining within the eye. 22,23 The performance of pars plana vitrectomy to retrieve the dislocated lens fragments at the time of cataract surgery may therefore be beneficial to minimise postoperative inflammation and its associated morbidity, as well as eliminate the need of two separate operations.…”

A retrospective study of patients with retained nuclear fragments after cataract extraction

“…In these reports no relationship was found between visual acuity or the development of chronic glaucoma and the timing of vitrectomy. However, some recent reports suggest that vitrectomy within a week is advantageous in reducing a number of complications (Tommila & Immonen 1995;Yeo et al 1999). A possible bias in retrospective studies on retained lens fragments may be a tendency to operate earlier the more severe the complications are.…”