Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments

Moore, Jeffrey K.; Scott, Ingrid U.; Flynn, Harry W.; Smiddy, William E.; Murray, Timothy G.; Kim, Judy E.; Vilar, Nancy F; Pereira, Maurício Bastos; Jorge, Rodrigo

doi:10.1016/s0161-6420(03)00020-4

Cited by 73 publications

(53 citation statements)

References 22 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. 25 Nonexcessive manipulation during the cataract operation, and appropriate manoeuvre during the vitrectomy procedure are of utmost importance in preventing this complication. Kapusta et al 11 reported no retinal detachment in their series, attributing to the fact that cataract surgeons in their institution are discouraged from attempting to retrieve the nuclear fragment from deep within the vitreous cavity.…”

Section: Discussionmentioning

confidence: 99%

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

Lai

Kwok

Yeung

et al. 2004

Eye

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Purpose To assess the outcome of patients who underwent instantaneous pars plana vitrectomy for dislocated lens fragments during cataract surgery. Methods The medical records of 29 patients who underwent immediate pars plana vitrectomy for dislocated lens fragments at the same sitting of phacoemulsification surgery were reviewed. Data including patients' demographics, preoperative and postoperative vision, risk factors for lens fragment dislocation, and intraoperative and postoperative complications were recorded. Results The mean follow-up period of the patients was 12.3 months (range, 3-47 months). The median preoperative visual acuity was 6/90 (range, LP to 6/15). The median final postoperative visual acuity was 6/18 (range, NLP to 6/9) and the mean improvement in vision after the operation was 4.5 lines. The commonest risk factors for dislocation of lens fragment were late detection of posterior capsule tear, splitting of anterior capsulorrhexis, and hard nucleus. After excluding nine eyes with other pre-existing ocular comorbidities, 10 (50%) eyes had a final visual acuity of 6/12 or better. Complications after surgery included three (10%) cases of retinal detachment and one (3%) patient developed epiretinal membrane. None of the patients in the study developed secondary glaucoma or cystoid macular oedema following surgery. Conclusion Immediate vitrectomy in the same sitting of the cataract surgery is a surgical option in the management of dislocated intravitreal lens fragments when vitreoretinal support is available. Most patients achieve a good visual outcome with reduced risk of secondary glaucoma and cystoid macular oedema after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Lai

Kwok

Yeung

et al. 2004

Eye

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“…9,24 Passing an instrument through the pars plana to retrieve a sinking lens nucleus is known as posterior-assisted levitation. This technique is claimed to be safe in some small series.…”

Section: Management: the Eyementioning

confidence: 99%

“…Leaving an eye, with a dropped lens nucleus, without an intraocular lens permits the removal of nuclear material from the posterior segment through the anterior chamber. There is a high incidence of retinal detachment at the time of nucleus removal 9 and an unstable intraocular lens or anterior chamber lens can complicate the use of internal tamponade. Perfluorocarbon liquids may be helpful in elevating a lens nucleus for removal through the anterior chamber.…”

Section: Management: the Eyementioning

confidence: 99%

“…[4][5][6][7] Posterior capsule disruption may be followed by dislocation of lens fragments into the posterior segment and those eyes have an even worse prognosis. 8,9 Prevention The minutiae of safe cataract surgery are outside the scope of this article and are dealt with in recent texts. 10,11 The incidence of vitreous loss depends on the experience of the surgeon, 6 surgical volume (number of cataract operations per surgeon in a year), 12,13 and the complexity of cases or case mix.…”

Section: Introductionmentioning

confidence: 99%

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Vitreous loss during cataract surgery: prevention and optimal management

Jacobs

2008

Eye

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Vitreous loss during cataract surgery is associated with a poor visual outcome. Experienced surgeons and those performing a high volume of cataract operations have lower rates of vitreous loss. Risk stratification systems, which allow prediction of intraoperative complications from preoperative criteria exist, so that less experienced surgeons can avoid higher risk cases. The management of vitreous loss includes counselling patients before surgery of the potential risks and complications. When vitreous loss occurs, it is important for the surgeon to avoid actions which increase the chance of disaster for the eye. These include phacoemulsification in the presence of vitreous and attempts to recover dropped lens fragments from the posterior segment without vitrectomy. There are advantages in performing an anterior vitrectomy by the pars plana route rather than through the anterior chamber and this approach is facilitated by sutureless 23-gauge instruments. Dislocation of lens nuclear fragments into the vitreous is associated with a high incidence of retinal detachment as well as secondary glaucoma and cystoid macular oedema. Early involvement of a retinal surgeon in the management of these eyes is recommended.

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