Article

Hybrid 20/23-gauge pars plana vitrectomy for retained lens fragments after cataract surgery.

Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.
Retina (Philadelphia, Pa.) (Impact Factor: 2.93). 03/2012; 32(9):1749-55. DOI: 10.1097/IAE.0b013e3182453309
Source: PubMed

ABSTRACT : To evaluate the outcome and surgery-associated risks in patients undergoing 23-gauge pars plana vitrectomy (PPV) for retained lens fragments.
: Retrospective analysis of 42 eyes of 42 consecutive patients at a tertiary teaching hospital in Sydney (Australia) during a period of 4 years. Evaluation of final visual acuity, complications, differences in patients receiving an intraocular lens at the primary cataract surgery, and differences in final visual acuity regarding the usage of a phacofragmatome and analysis of pars plana vitrectomy-related complications.
: The majority (83.3%) achieved a visual acuity of 0.3 (logarithm of the minimum angle of resolution) or better, and 19 eyes (45.2%) achieved a final visual acuity of 0 (logarithm of the minimum angle of resolution). Overall, 95.2% of the eyes had a better postoperative visual acuity compared with the preoperative visual acuity. There were no differences in proportions regarding the final visual acuity in patients who had an intraocular lens at the time of the pars plana vitrectomy and those who had a secondary lens implant. A retinal detachment after the lens fragment removal was observed in 2 eyes.
: Dropped lens fragments because of complicated cataract surgery can be managed well with 23-gauge pars plana vitrectomy: The majority of patients achieve a good visual acuity despite 2 surgeries at a rather low rate of retinal complications.

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    ABSTRACT: Posterior capsular rupture (PCR) is an infrequent complication of cataract surgery that can lead to significant ocular morbidity and permanent vision loss. In the setting of PCR, the primary objective is the safe and thorough evacuation of vitreous and lens fragments from the anterior segment. The secondary objective is the stable placement of an intraocular lens (IOL) selected for best refractive outcomes. Expedited referral to vitreoretinal specialists is recommended for management of posteriorly dislocated lens material and surveillance for retinal injury. It is the intention of this review to present current guidelines for the management of PCR. There are new techniques available to anterior and posterior segment surgeons in the setting of PCR. Endoillumination may facilitate visualization during anterior vitrectomy and the IOL may be used as a pupillary barrier to prevent loss of lens fragments. When secondary procedures are needed, early return to the operating room and small-gauge pars plana techniques may reduce patient morbidity. When approached carefully and systematically, patients may have good outcomes in the setting of PCR. Recent advancements in instrumentation and technique encourage further study and may lead to new standards of care.
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