Vitrectomy and lensectomy in the management of posterior dislocation of lens fragments

Purpose: To study the visual results and complications in patients treated by vitrectomy and lensectomy for posterior dislocation of lens fragments du ring phacoemulsification. Setting: University Hospital of Wales, Cardiff, United Kingdom. Methods: This retrospective study was carried out between 1995 and 1998. Ei ghteen patients had a vitrectomy and lensectomy for posterior dislocation o f lens fragments. The referral patterns, the presenting features, and the c omplications were recorded. The patients were invited for a final review to assess and record the final visual outcome and for a detailed ocular exami nation. Results: The median age of the patients was 76 years. The youngest patient was 62 years and the oldest, 87 years. The median time of referral was 1 da y(range 0 to 67 days). The median timing of the surgery was 6 days (range 2 to 77 days); however, 5 patients had a vitrectomy-lensectomy performed at the time of cataract surgery (day 0). Uveitis was present in 100% of patien ts, corneal edema in 76.0%, and ocular hypertension in 38.4%. Median follow -up was 12 months (range 6 to 34 months). Visual acuity was 6/12 or better in 83.3% of patients. Two patients were treated for retinal tears, 2 had po stoperative uveitis, 2 had macular pucker. and 2 had ocular hypertension. T here was no statistically significant association between final visual outc ome and grade of the surgeon performing the cataract operation, the presenc e of an intraocular lens at the time of cataract surgery, the timing of the vitrectomy-lensectomy, or the presence of previtrectomy uveitis or high in traocular pressure (IOP). Conclusions: Early recognition of dislocated lens fragments and prompt asse ssment for vitrectomy-lensectomy produced excellent visual results and few complications. The comeal edema, uveitis, and high IOP resolved with the vi trectomy-lensectomy. (C) 2000 ASCRS and ESCRS.