Management of retained lens fragments in complicated cataract surgery

To evaluate and review the current literature on the management of retained lens material with pars plana vitrectomy (PPV) and lensectomy after complicated cataract surgery.

Recent studies on retained lens fragments in cataract surgery support early referral to a vitreoretinal specialist, and indicate that visual outcomes are favorable with current vitrectomy and lensectomy techniques. Nearly 83% of patients without preexisting eye disease who undergo PPV achieve visual acuity of 20/40, whereas 5.5% of patients have postoperative acuity of 20/200 or worse. In a multivariate analysis, the predictors for 20/40 or better vision were presenting acuity, insertion of a posterior chamber lens at the time of cataract surgery, and absence of preoperative eye disease. Retinal detachment and secondary glaucoma were the major causes of ocular morbidity. Most retrospective studies assessing the timing of vitrectomy and lensectomy show no advantage for early (within 1 week) PPV. Delayed vitrectomy beyond 30 days is associated with poorer outcomes. With technological advances, small gauge vitrectomy is considered a viable alternative surgical approach to standard vitrectomy with phacofragmentation.

Given favorable outcomes reported with planned PPV, the primary intraoperative goals of the cataract surgeon encountering posterior displacement of lens material are to remove lens material that is accessible from the anterior approach, remove vitreous from the anterior segment, and place an anterior or preferably posterior chamber intraocular lens. Early involvement of the retinal surgeon facilitates the evaluation and timing for vitrectomy and lensectomy based on the clinical course.