[Surgery in posterior luxated lens fragments through intravitreal phacofragmentation]

To assess the intra and postoperative difficulties, the anatomical and functional results after intravitreal phacoemulsification during pars plana vitrectomy for retained intraocular lens fragments.

Retrospective, non-comparative case series of 48 eyes who underwent vitrectomy for posterior dislocated lens fragments during phacoemulsification between January 2000 and January 2010. In 11 cases the vitrectomy was performed immediately, within 24 hours, and in 37 cases it was delayed 2 to 10 days after cataract surgery. During pars plana vitrectomy the lens fragments were separated of vitreous strings and then phacoemulsification was performed into the center of vitreous cavity. All cases were performed under local anesthesia by the same surgeon. During vitrectomy PFCL was used in 5 cases to protect central retina. Cases were followed-up at least 6 months. Statistical analysis was performed using Wilcoxon and chi square tests.

Mean age in the study group was 65.38% 9.49 years (ranging 52-82 years). The mean visual acuity improved from 0.12% 0.07 (0.04-0.3) preoperatively to 0.3% 0.2 (0.05-0.6) postoperatively (p < 0.01). Mean intraocular pressure decreased postoperatively from 26.24% 9.3 mmHg (16-48 mmHg) to 15.95% 3.69 mmHg(12-24 mmHg) (p < 0.01). In all cases corneal edema and intraocular inflammation ceased after vitrectomy. In those 11 cases operated immediately the intravitreal phacoemulsification time was longer, as well as greater number of intraoperative complication (corneal edema, corneal leakage). In 4 out of these 11 cases (36.36%) severe postoperative retinal complications were noticed (2 cases of retinal detachment, 1 case of choroidal detachment and 1 case of choroidal hematoma). In the delayed group the only postoperative complication was cystoid macular edema in 9 out of 37 cases (24.32%).

Removal of retained intraocular lens fragments suspended the intraocular inflammation and normalized intraocular pressure in all cases. Our results are in favor of delayed procedure that might be safer and easier.