Visual outcome following immediate pars plana vitrectomy for posteriorly dislocated intravitreal lens fragments during phacoemulsification

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Visual outcome following immediate pars plana
vitrectomy for posteriorly dislocated
intravitreal lens fragments during
phacoemulsification

• Karen Chia, MDChan Tat Keong, MDPeter Tseng,
  MDDoric Wong, MD

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Purpose

• To evaluate visual outcomes and complications in
  patients with immediate pars plana vitrectomy for
  posteriorly dislocated intravitreal lens
  fragments during phacoemulsification

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Methods

• Patients with posteriorly dislocated intravitreal
  lens fragments during phacoemulsification
• Underwent immediate pars plana vitrectomy by a
  vitreoretinal surgeon
• As part of the routine management strategy in a
  tertiary eye center.
• A retrospective review of all consecutive cases
  from 2001 to 2006 was performed.
• Data collected included demographics, best
  corrected visual acuity (BCVA) and complications
  including retinal detachment, raised intraocular
  pressure (IOP) and cystoid macular edema (CME).

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Results

• Demographics
• 45 eyes of 46795 cases of phacoemulsification
  were included in the study
• Median age of patients 69 years
• Median follow-up 11 months after vitrectomy.

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Best Corrected Visual Acuity
Median BCVA (logMar) Median BCVA (Snellen) Range (logMar)
All patients 0.18 20/30 0.28 /- 0.41
After excluding cases with pre-existing ocular problems 0.1 20/25 0.17 /- 0.16
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Patients with BCVA 20/40 or better
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IOL implant
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Complications of dropped nucleus
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Complications of dropped nucleus
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Retina Complications
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Factors associated with poor visual outcome
BCVA worse than 20/40 p value
Position of IOL implant Anterior Chamber 0.047
Presenting VA Worse than 20/60 0.042
Pre-existing ocular problems Present 0.457
Primary lens implant Present 0.364
Retinal Complications Present 0.586
Glaucoma Complications Present 0.36
Fishers exact test
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Conclusion

• The majority of cases of posteriorly dislocated
  intravitreal lens fragments had good visual
  outcome. Immediate pars plana vitrectomy has
  minimal sight-threatening complications and is a
  good management strategy to adopt in a tertiary
  setting.