Management of Retained Lens Fragments after Phacoemulsification

Abstract

Purpose. Retained lens fragments after phacoemulsification is a serious complication. The authors conducted this study to provide a guideline in the management of retained lens fragments after phacoemulsification and the visual outcome after vitrectomy. Methods. The authers performed a retrospective chart review of 25 patients who had retained lens fragments (extensive cortical material and! or nucleus) after phacoemulsification cataract operation from July 1992 to April 1995. Results. Clinical features of retained lens fragments included decreased visual acuity 6/60 or worse (68%), persistent intraocular inflammation (52%), glaucoma (28%), corneal edema (28%) and retinal detachment in one patient (4%). There were twelve patients who underwent pars plana vitrectomy, the other twelve patients received ocutome anterior vitrectomy. After vitrectomy, 17 eyes (77%) got visual improvement, and final visual acuity was 6/12 or better in 13 eyes (54%). The interval between vitrectomy and phacoemulsification operation was within 4 weeks in 17 patients (71%), ranged from on the same day to 97 days. Using the percentage of patients with 6/12 or better final visual acuity, there was no statistical difference in surgery performed within 7 days (67%), between 8 and 27 days (37.5%), and after 28 days (57%). About the initial IOL status, 16 patients had PCIOL put on capsular remnant or sulcus, 6 patients had sutured PCIOL, and 3 patients was left aphakic. There was no statistical difference between initial IOL status and final visual acuity. The causes of poor visual outcome of 6/60 or worse included maculopathy, cystoid macular edema and chronic glaucoma. Conclusion. Retained lens fragments after phacoemulsification is a potentially devastating complication. We recommend avoid excessive irrigation or searching lens fragments posteriorly during cataract operation to decrease the risk of retinal detachment. In most patients (77%), visual improvement was achieved after removal of lens fragments with vitrectomy management. The visual outcome is not statistically influenced by the timing of vitrectomy, the inital IOL status and methods of surgical approach.