Staining of vitreous with triamcinolone acetonide in retained lens surgery with phacofragmentation

To evaluate the beneficial effects of triamcinolone-assisted vitrectomy during management of retained nuclei with phacofragmentation.

Dokuz Eylul University, Medical Faculty, Ophthalmology Department, and Retina Eye Center, Izmir, Turkey.

Twelve eyes of 12 patients were operated on between January 2002 and September 2003. Eleven patients were referred because of nucleus drop during phacoemulsification surgery. Six of these patients had mature white cataracts, and in 5 cases total nucleus luxation into vitreous cavity had occurred. In 1 case, approximately half of the nucleus was luxated. Five of the referred patients had pseudoexfoliation (PEX), 3 of whom also had phacodonesis. All of these patients had luxated nucleus segments of more than half. One patient was referred with an intraocular lens (IOL) implanted in the sulcus region. One patient who was not referred also had PEX, iridodonesis, and phacodonesis; total drop of nucleus had occurred in this case. All patients were treated with pars plana vitrectomy with triamcinolone acetonide staining of the vitreous material and phacofragmentation of the dropped nucleus segments. In 2 cases, transscleral foldable IOL fixation surgery was combined simultaneously. One patient already had an IOL at the time of referral. Nine patients were left aphakic for secondary procedures.

All patients except 1 with subretinal neovascular membrane achieved best corrected visual acuities of equal or better than 0.5. No intraoperative or postoperative retinal complications were observed after 9 to 15 months of follow-up.

Staining of the vitreous material with triamcinolone acetonide during vitrectomy and phacofragmentation surgery for luxated nuclei helped in total removal of the vitreous body, thus preventing the aspiration of peripheral vitreous fibrils by the phaco tip, which might induce retinal detachment intraoperatively or postoperatively.