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International Ophthalmology

, Volume 38, Issue 6, pp 2699–2707 | Cite as

Timing of vitrectomy for retained lens fragments after cataract surgery

  • Travis PeckEmail author
  • Janice Park
  • Asima Bajwa
  • Yevgeniy Shildkrot
Review

Abstract

Purpose

To determine the outcomes of early (less than 7 inter-operative days) versus late (7 or greater inter-operative days) vitrectomy in patients with retained lens fragments in the posterior segment after cataract surgery.

Methods

This was a retrospective review of all patients underwent pars plana vitrectomy for retained lens fragments at the University of Virginia Hospital from 2002 to 2015.

Results

Forty-one eyes were included in the analysis. Mean follow-up time was 25.3 months (range 3.2 months-13 years). Patients in the early vitrectomy group had poorer baseline visual acuity than those in the late vitrectomy group (mean logMAR, 1.10 vs. 0.53, p = 0.030). No other pre-operative differences existed between the two groups. At the final follow-up, there was no significant difference in visual acuity between the early (mean logMAR, 0.41) and the late (mean logMAR, 0.45) vitrectomy groups. There were no differences in rates of glaucoma, retinal detachment, or cystoid macular edema between the groups. Factors associated with final visual acuity of worse than 20/40 were diabetes mellitus, placement of anterior chamber intraocular lens at cataract surgery, cortical as opposed to nuclear retained lens fragments, post-cataract extraction complications, need for glaucoma medications, and additional surgery after vitrectomy. Separate analysis was done for patients with pre-existing eye disease resulting in worse than 20/40 vision, which showed.

Conclusion

Clinical outcomes were similar in patients undergoing early and late vitrectomy. Patients with poorer baseline visual acuity were more likely to receive early vitrectomy. Worse final visual acuity was seen in patients with baseline diagnosis of diabetes and in those who experienced post-operative complications.

Keywords

Retained lens fragments Pars plana vitrectomy Retained cortex Retained nucleus Cataract complications Timing of vitrectomy for retained lens fragments 

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ho LY, Doft BH, Wang L, Bunker CH (2009) Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Am J Ophthalmol 147(4):587–594CrossRefGoogle Scholar
  2. 2.
    Pande M, Dabbs TR (1996) Incidence of lens matter dislocation during phacoemulsification. J Cataract Refract Surg 22(6):737–742CrossRefGoogle Scholar
  3. 3.
    Vanner EA, Stewart MW (2014) Meta-analysis comparing same-day versus delayed vitrectomy clinical outcomes for intravitreal retained lens fragments after age-related cataract surgery. Clin Ophthalmol 8:2261–2276PubMedPubMedCentralGoogle Scholar
  4. 4.
    Chalam KV, Murthy RK, Priluck JC, Khetpal V, Gupta SK (2015) Concurrent removal of intravitreal lens fragments after phacoemulsification with pars plana vitrectomy prevents development of retinal detachment. Int J Ophthalmol 8(1):89–93CrossRefGoogle Scholar
  5. 5.
    Cohen SM, Davis A, Cukrowski C (2006) Cystoid macular edema after pars plana vitrectomy for retained lens fragments. J Cataract Refract Surg 32(9):1521–1526CrossRefGoogle Scholar
  6. 6.
    Kim IK, Miller JW (2002) Management of dislocated lens material. Semin Ophthalmol 17(3–4):162–166CrossRefGoogle Scholar
  7. 7.
    Moore JK, Scott IU, Flynn HW et al (2003) Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Ophthalmology 110(4):709–713 (discussion 713–714) CrossRefGoogle Scholar
  8. 8.
    Vilar NF, Flynn HW, Smiddy WE, Murray TG, Davis JL, Rubsamen PE (1997) Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Ophthalmology 104(5):787–791 (discussion 787–794) CrossRefGoogle Scholar
  9. 9.
    Blodi BA, Flynn HW, Blodi CF, Folk JC, Daily MJ (1992) Retained nuclei after cataract surgery. Ophthalmology 99(1):41–44CrossRefGoogle Scholar
  10. 10.
    Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT (2008) Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Ophthalmologica 222(4):277–283CrossRefGoogle Scholar
  11. 11.
    Merani R, Hunyor AP (2009) Medical versus surgical management of retained lens fragments. J Cataract Refract Surg 35(12):2181 (author reply 2181) CrossRefGoogle Scholar
  12. 12.
    Scott IU, Flynn HW, Smiddy WE et al (2003) Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Ophthalmology 110(8):1567–1572CrossRefGoogle Scholar
  13. 13.
    Colyer MH, Berinstein DM, Khan NJ et al (2011) Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Retina 31(8):1534–1540CrossRefGoogle Scholar
  14. 14.
    Modi YS, Epstein A, Smiddy WE, Murray TG, Feuer W, Flynn HW (2013) Retained lens fragments after cataract surgery: outcomes of same-day versus later pars plana vitrectomy. Am J Ophthalmol 156(3):454–459CrossRefGoogle Scholar
  15. 15.
    Orlin A, Parlitsis G, Chiu YL, D’Amico DJ, Chan RV, Kiss S (2014) A comparison of same setting versus delayed vitrectomy in the management of retained lens fragments after cataract surgery. Retina 34(10):1969–1976CrossRefGoogle Scholar
  16. 16.
    Scupola A, Abed E, Sammarco MG et al (2015) 25-Gauge pars plana vitrectomy for retained lens fragments in complicated cataract surgery. Ophthalmologica 234(2):101–108CrossRefGoogle Scholar
  17. 17.
    Vanner EA, Stewart MW (2011) Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis. Am J Ophthalmol 152(3):345–357CrossRefGoogle Scholar
  18. 18.
    Aasuri MK, Kompella VB, Majji AB (2001) Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 27(9):1428–1432CrossRefGoogle Scholar
  19. 19.
    Kapusta MA, Chen JC, Lam WC (1996) Outcomes of dropped nucleus during phacoemulsification. Ophthalmology 103(8):1184–1187CrossRefGoogle Scholar
  20. 20.
    Romero-Aroca P, Fernández-Ballart J, Méndez-Marín I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA (2007) Management of nucleus loss into the vitreous: long term follow up in 63 patients. Clin Ophthalmol 1(4):505–512PubMedPubMedCentralGoogle Scholar
  21. 21.
    Olsson RB, Ritland JS, Bjørnsson OM, Syrdalen P, Eide N, Overgård R (2000) A retrospective study of patients with retained nuclear fragments after cataract extraction. Acta Ophthalmol Scand 78(6):677–679CrossRefGoogle Scholar
  22. 22.
    Oruc S, Kaplan HJ (2001) Outcome of vitrectomy for retained lens fragments after phacoemulsification. Ocul Immunol Inflamm 9(1):41–47CrossRefGoogle Scholar
  23. 23.
    Smiddy WE, Guererro JL, Pinto R, Feuer W (2003) Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Am J Ophthalmol 135(2):183–187CrossRefGoogle Scholar
  24. 24.
    Al-Amri AM (2008) Visual outcome of pars plana vitrectomy for retained lens fragments after phacoemulsification. Middle East Afr J Ophthalmol 15(3):107–111CrossRefGoogle Scholar
  25. 25.
    Kim NR, Yoon JH, Kang SM, Chin HS (2009) Intravitreal triamcinolone acetonide injection at the time of pars plana vitrectomy for retained lens material. Kor J Ophthalmol 23(1):13–16CrossRefGoogle Scholar
  26. 26.
    Ho LY, Walsh MK, Hassan TS (2010) 25-Gauge pars plana vitrectomy for retained lens fragments. Retina 30(6):843–849CrossRefGoogle Scholar
  27. 27.
    Ho SF, Zaman A (2007) Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. J Cataract Refract Surg 33(12):2106–2110CrossRefGoogle Scholar
  28. 28.
    Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L (1996) Outcomes of vitrectomy for retained lens fragments. Ophthalmology 103(6):971–976CrossRefGoogle Scholar
  29. 29.
    Moisseiev E, Kinori M, Glovinsky Y, Loewenstein A, Moisseiev J, Barak A (2011) Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments. Eur J Ophthalmol 21(6):741–747CrossRefGoogle Scholar
  30. 30.
    Smiddy W, Flynn H (1996) Managing retained lens fragments and dislocated posterior chamber IOLs after cataract surgery. Focal points: clinical modules for ophthalmologists. Vol Module 7. San Francisco: American Academy of OphthalmologyGoogle Scholar
  31. 31.
    Stefaniotou M, Aspiotis M, Pappa C, Eftaxias V, Psilas K (2003) Timing of dislocated nuclear fragment management after cataract surgery. J Cataract Refract Surg 29(10):1985–1988CrossRefGoogle Scholar
  32. 32.
    Vanner EA, Stewart MW, Liesegang TJ, Bendel RE, Bolling JP, Hasan SA (2012) A retrospective cohort study of clinical outcomes for intravitreal crystalline retained lens fragments after age-related cataract surgery: a comparison of same-day versus delayed vitrectomy. Clin Ophthalmol 6:1135–1148PubMedPubMedCentralGoogle Scholar
  33. 33.
    Gonvers M (1994) New approach to managing vitreous loss and dislocated lens fragments during phacoemulsification. J Cataract Refract Surg 20(3):346–349CrossRefGoogle Scholar
  34. 34.
    Kim JE, Flynn HW, Smiddy WE et al (1994) Retained lens fragments after phacoemulsification. Ophthalmology 101(11):1827–1832CrossRefGoogle Scholar
  35. 35.
    Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S (2001) Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Br J Ophthalmol 85(9):1038–1040CrossRefGoogle Scholar
  36. 36.
    Wilkinson CP, Green WR (2001) Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Ophthalmology 108(9):1633–1637CrossRefGoogle Scholar
  37. 37.
    Salehi A, Razmju H, Beni AN, Beni ZN (2011) Visual outcome of early and late pars plana vitrectomy in patients with dropped nucleus during phacoemulsification. J Res Med Sci 16(11):1422–1429PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.Department of OphthalmologyUniversity of VirginiaCharlottesvilleUSA

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