Small-gauge transconjunctival vitrectomy with phacoemulsification in the pupillary plane of dense retained lens matter on perfluorocarbon liquids after complicated cataract surgery

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To evaluate the visual outcomes, efficacy, and complications of 23-gauge pars plana vitrectomy followed by phacoemulsification using torsional ultrasound of dense retained lens matter on perfluorocarbon liquids (PFCLs) after complicated cataract surgery. The case notes of 34 consecutive patients operated upon with retained lens matter after complicated cataract surgery by one surgeon were reviewed. Twenty-one of the 32 cases were able to be managed using the vitrectomy cutter alone, but 13 cases with dense lens matter were managed using 23-G vitrectomy followed by torsional ultrasound of the retained lens via the original corneal incision after floating it up to the pupillary plane on PFCLs. Case notes of these 13 patients were reviewed to ascertain clinical features, results, and any complications. The mean age of the 13 patients was 79years. The procedure was completed in all cases without using an intravitreal fragmatome. All cases were aphakic prior to vitrectomy surgery. Ten patients had a sulcus fixated IOL inserted at the time of vitrectomy and three had an angle-supported anterior chamber IOL inserted. Mean post-operative visual acuity at 3months was 0.24 (median 6/9). Eleven of the 13 patients (85%) had a best postoperative corrected visual acuity of ≥6/12. One patient developed cystoid macular oedema that was successfully treated. There were no cases of retinal detachment. The outcome of 13 patients operated on with transconjunctival vitrectomy with phacoemulsification of dense retained lens matter on top of PFCLs is described. The technique was used successfully, with good visual acuity outcomes and a low complication rate.