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Management of dislocated lens fragments during phacoemulsification.

Abstract：

BACKGROUND:Dislocation of nuclear lens fragments during phacoemulsification can lead to a high incidence of glaucoma, uveitis, and poor visual acuity. The correct approach to these patients is uncertain. The authors report on eight patients who underwent pars plana vitrectomy with removal of lens fragments. METHODS:Charts of eight consecutive patients who developed dislocation of nuclear lens fragments into the vitreous cavity during phacoemulsification were retrospectively reviewed. All patients underwent a standard three-port pars plana vitrectomy with removal of the dislocated nuclear fragments by pars plana fragmentation. After the vitrectomy, the retina was inspected with indirect ophthalmoscopy. Tears were treated with cryopexy. A fluid-air exchange and scleral buckle were performed when indicated. RESULTS:Retinal tears were located at the vitreous base in four of eight patients. After vitrectomy, visual acuity improved in all patients, with 7 of 8 patients achieving visual acuity of 20/40 or better. The type of pseudophakia did not influence the final visual acuity. There were no cases of glaucoma, uveitis, or macular edema with up to 22 months of follow-up. CONCLUSIONS:These results suggest that large nuclear fragments dislocated into the posterior segment during phacoemulsification can be removed safely with pars plana vitrectomy and lensectomy with an excellent visual prognosis. Attempts to remove lens fragments during the phacoemulsification through an anterior wound should be avoided because of excessive vitreous traction, leading to retinal break formation.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Lambrou FH Jr,Stewart MW

doi

10.1016/s0161-6420(92)31805-6

subject

Has Abstract

pub_date

1992-08-01 00:00:00

pages

1260-2; discussion 1268-9

issue

8

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(92)31805-6

journal_volume

99

pub_type

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