Management of dislocated lens fragments during phacoemulsification

Area of Science:

• Ophthalmology
• Surgical Techniques

Background:

• Dislocation of nuclear lens fragments during phacoemulsification is a known complication.
• This complication can lead to serious ocular issues, including glaucoma, uveitis, and reduced visual acuity.
• Optimal management strategies for dislocated nuclear fragments remain uncertain.

Purpose of the Study:

• To evaluate the safety and efficacy of pars plana vitrectomy with lensectomy for managing dislocated nuclear lens fragments.
• To assess visual outcomes and complication rates in patients undergoing this procedure.

Main Methods:

• Retrospective review of eight consecutive patients with nuclear fragments dislocated into the vitreous cavity during phacoemulsification.
• All patients underwent a three-port pars plana vitrectomy with fragmentation and removal of dislocated nuclear fragments.
• Post-vitrectomy retinal inspection, treatment of retinal tears with cryopexy, and fluid-air exchange/scleral buckle when indicated were performed.

Main Results:

• Improved visual acuity in all eight patients post-vitrectomy, with seven achieving 20/40 or better.
• No cases of glaucoma, uveitis, or macular edema were observed during follow-up (up to 22 months).
• Retinal tears at the vitreous base were noted in four patients and treated successfully.

Conclusions:

• Pars plana vitrectomy and lensectomy offer a safe and effective approach for removing large nuclear fragments dislocated into the posterior segment.
• This surgical technique is associated with an excellent visual prognosis and a low complication rate.
• Avoiding anterior wound attempts for fragment removal during phacoemulsification is recommended to prevent vitreous traction and retinal breaks.