MANAGEMENT OF DISLOCATED LENS FRAGMENTS AFTER PHACOEMULSIFICATION SURGERY

Objective: To describe the management and visual outcome of patients w ith dislocated nuclear lens fragments. Design: Case series. Setting: R etina service at a university-affiliated hospital in Vancouver. Patien ts: Fifty-four consecutive patients (28 men and 26 women) with retaine d lens fragments following phacoemulsification surgery referred for ma nagement from May 1990 to May 1994. The patients' ages ranged from 41 to 94 (average 74) years. Results: Initial ocular findings in 52 patie nts included moderate or severe corneal edema in 23 cases (44%), intra ocular pressure greater than 25 mm Hg in 24 (46%), intraocular inflamm ation in 36 (69%), retinal detachment in 2 (4%) and vitreous hemorrhag e in 4 (8%). Of the eight patients managed conservatively with medical therapy six (75%) regained 20/40 or better vision. The remaining 46 p atients underwent pars plana vitrectomy. The final visual acuity in th is group was 20/40 or better in 30 patients (65%), 20/50 to 20/100 in 8 (17%) and 20/200 or worse in 8 (17%). Patients who had an anterior c hamber intraocular lens (IOL) implanted at cataract surgery had a sign ificantly poorer visual outcome than those who received a posterior ch amber IOL at vitrectomy (I, = 0.03).Conclusions: When a significant se gment of nucleus has dislocated during phacoemulsification surgery, vi gorous irrigation or direct attempts to remove the lens fragments shou ld be avoided, Anterior vitrectomy should be performed, and if adequat e capsular support remains, a posterior chamber IOL should be inserted into the ciliary sulcus.