Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus after Phacoemulsification

To determine the prognostic factors and visual and anatomic outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).

The records of patients with complicated PE who underwent PPV to remove posteriorly dislocated nucleus fragments from January 2011 to December 2014 were retrospectively reviewed.

Of 43 patients, 36 patients (36 eyes) were included with mean age of 73 ± 9.5 years and mean follow-up duration of 23.8 ± 15.3 (range 4-53) months. The mean interval between cataract surgery and PPV was 11.5 ± 9.6 (range 1-45) days. The pre-PPV mean best-corrected visual acuity (VA) was 1.04 ± 0.24 logMAR, which improved to 0.46 ± 0.18 logMAR (P < 0.001). Pre-PPV VA ≥20/200 was significantly associated with good final VA ≥20/40 (P = 0.002). Implantation of intraocular lens (IOL) at the time of complicated PE and complicated course after PPV were significantly associated with poor visual outcome of <20/40 (P = 0.041 and P < 0.001, respectively). However, the timing of PPV, route of nucleus removal, and final IOL status were not significantly associated with the visual outcome. The most frequent causes of poor visual outcome were optic atrophy, cystoid and/or diabetic macular edema, history of rhegmatogenous retinal detachment, and pre-existing eye disease (age-related macular degeneration).

PPV for dropped nucleus was associated with improved VA. Better pre-PPV VA was associated with good visual outcome, while inserting IOL at the time of complicated PE, and complicated course after PPV were associated with poor visual outcome.