REMOVAL OF LENS FRAGMENTS FROM THE VITREOUS CAVITY

Between March 1993 and September 1994 we treated 25 cases of lenses in the vitreous cavity. Nineteen of the 25 were the result of dislocatio n during phacoemulsification. During this time, we adopted a single su rgical algorithm involving vitrectomy, heavy liquids and ultrasound fr agmentation, The aims of this retrospective study were to test the val idity of our surgical algorithm and to report on outcomes and complica tions, The indications for vitreous surgery were raised intraocular pr essure, uveitis and poor vision, Vitreous surgery was carried out at a mean of 29 days following phacoemulsification. Six patients required heavy liquids and 5 needed ultrasound fragmentation, Vitreous surgery undertaken less than 17 days after phacoemulsilication had an increase d likelihood of requiring heavy liquids and/or fragmentation (p<0.02), The greatest threat to a favourable visual outcome was retinal detach ment, which was significantly associated ,vith fragmentation and use o f heavy liquids (p<0.02). The presence of an intraocular lens (IOL) re duced the surgical options for removal of the lens fragments, and IOL should not be inserted where lens matter dislocates, The study suggest s that we should avoid fragmentation and, provided the intraocular pre ssure and uveitis can be controlled, that vitreous surgery should be d eferred for 2-3 weeks following phacoemulsification.