Phacofragmentation of Posteriorly Dislocated Lens Fragments: Limbal versus Pars Plana Approach

Area of Science:

• Ophthalmology
• Surgical Techniques
• Retinal Surgery

Background:

• Managing dropped crystalline lens fragments in the vitreous cavity requires specific surgical techniques.
• The pars plana approach is a common method for vitreous cavity fragment removal.
• Evaluating alternative approaches for improved safety and feasibility is crucial.

Purpose of the Study:

• To compare the intra-operative complication rates of removing crystalline lens fragments from the vitreous via a limbal incision versus a pars plana approach.
• To assess the feasibility of completing crystalline lens fragment removal using solely a limbal incision.

Main Methods:

• A retrospective cohort study comparing 16 eyes undergoing limbal approach (Group A) with 9 eyes undergoing pars plana approach (Group B).
• Data collected included pre-operative, intra-operative, and post-operative parameters.
• Outcomes measured were intra-operative complications (e.g., corneal wound burn, iris/capsular damage, retinal tears, hemorrhage) and post-operative best-corrected visual acuity (BCVA) and intraocular pressure (IOP).

Main Results:

• No significant differences were observed in the incidence of intra-operative complications between the limbal and pars plana groups (p > 0.99).
• Post-operative outcomes, including BCVA and rates of corneal edema, choroidal detachment, or retinal detachment, were similar between groups.
• All cases in the limbal group were completed without requiring a switch to the pars plana approach, demonstrating feasibility.

Conclusions:

• Phacofragmentation through a limbal incision is a feasible and safe technique for managing dropped nuclear fragments.
• The limbal approach does not appear to increase the risk of complications compared to the traditional pars plana route.
• This technique offers a viable alternative for vitreous fragment removal in cataract surgery.