VITRECTOMY FOR RETAINED LENS FRAGMENTS AFTER PHACOEMULSIFICATION

Purpose: Posterior lens fragments after phacoemulsification can be a s erious complication of cataract surgery, This study is designed to eva luate the clinical features of eyes after pars plana vitrectomy has be en performed to remove posteriorly dislocated lens fragments after pha coemulsification. Methods: The authors performed a retrospective chart review of 126 consecutive eyes of 126 patients with dislocated lens f ragments after phacoemulsification, managed with pars plana vitrectomy at Associated Retinal Consultants of Michigan. These eyes were operat ed on from January 1986 through January 1996. Results: The relation of the intervals between cataract surgery and vitrectomy to various post operative clinical parameters was studied. Clinical features at presen tation included elevated intraocular pressure (IOP over 25 mmHg) in 52 .4% of the eyes, uveitis in 69.6%, and corneal edema in 50.8%. Initial visual acuity was 20/400 or worse in 73.8% of the eyes. The mean preo perative visual acuity was 20/278 (median, 20/400), whereas the mean f inal visual acuity was 20/40 (median, 20/50) after a mean follow-up of 18.9 months, Retinal detachments were found in 20 eyes: 7 before vitr ectomy and 13 during or after it, After surgery, 44% of eyes achieved a final visual acuity of 20/40 or better and 90% were 20/400 or better . The distribution of best-corrected final visual acuities among the e yes showed statistically significant differences based on the type of intraocular lens (IOL) used, with posterior chamber IOL greater than a nterior chamber IOL, and anterior chamber IOL greater than aphakia. Re asons for a poor visual outcome included persistent corneal edema (fou r eyes), retinal detachment (two eyes), central retinal vein occlusion (two eyes), age-related macular degeneration (two eyes), glaucoma (on e eye), and endophthalmitis (one eye). Conclusions: There were no stat istically significant differences between early (<7 days) and delayed (8 days or more) vitrectomy when increased IOP, corneal edema, choroid al effusions, cystoid macular edema, and visual acuity were analyzed. The use of vitrectomy to remove posteriorly dislocated lens fragments has been shown to be an effective treatment method that significantly reduces the inflammatory response and hastens visual recovery.