VITRECTOMY WITH ENDOSCOPY FOR MANAGEMENT OF RETAINED LENS FRAGMENTS AND OR POSTERIORLY DISLOCATED INTRAOCULAR-LENS/

Purpose: To evaluate the advantages of vitrectomy combined with endosc opy for the management of retained lens fragments and/or posteriorly d islocated intraocular lens (IOL). Methods: A consecutive series of 30 eyes with these complications treated by this technique was reviewed r etrospectively. An endoscopic probe which incorporates a video channel , a fibreoptic light source, and a diode laser was used for visualizat ion. Lens material or the IOL was extracted through the corneal wound in 18 eyes (60%). They were either aspired or grasped or lifted using perfluorocarbon liquids (PFCL), under endoscopic control. In 9 eyes (3 0%) pars plana phakoemulsification was performed. PFCL was used in 11 eyes (36.6%). In 16 eyes (53.3%) an IOL was sutured in the ciliary sul cus. Results: Final visual acuity was greater than or equal to 20/40 i n 19 eyes (63.3%), greater than or equal to 20/30 in 15 eyes (50%). In traoperative breaks occurred early in the series in two eyes (in one c ase from use of the endoprobe, in the other from pars plana phakoemuls ification). Poor final acuity was related to proliferative vitreoretin opathy, which developed in both cases with an intraoperative iatrogeni c retinal break, senile macular degeneration, myopia and amblyopia, cy stoid macular oedema, corneal oedema and high astigmatism. Conclusion: We found that endoscopy facilitated the management of these complicat ions of caratact surgery once the peculiar difficulties of the techniq ue (absence of stereoscopy, manipulation of the endoprobe, video monit or control) were mastered. Endoscopy facilitated and shortened localiz ation of lens fragments embedded into the vitreous base for aspiration , grasping and phakoemulsification, enabled detection of small anterio r retinal breaks, permitted resection of adhesions between anterior hy aloid, lens capsule and ciliary sulcus and facilitated PFCL manipulati ons, whatever the status of the anterior segment (corneal edema, myosi s, synechiae, presence of IOL).