Timing of dislocated nuclear fragment management after cataract surgery

Abstract

Purpose To determine the timing of vitrectomy in patients with dislocated nuclear fragments after phacoemulsification and to correlate timing with visual outcomes. Setting University Eye Clinic of Ioannina, Ioannina, Greece. Methods This was a retrospective review of the records of 26 patients who had phacoemulsification at the University Eye Clinic of Ioannina over a 5-year period. The mean age of the 13 men and 13 women was 66.9 years (range 59 to 80 years). All patients had nucleus or nuclear fragment dislocation into the vitreous cavity during phacoemulsification and had vitrectomy and removal of the dislocated nucleus. The postoperative follow-up ranged from 3 to 9 months. Results Eight patients (30.8%) had vitrectomy at the time of phacoemulsification (Group A), 8 (30.8%) within 3 weeks (Group B), and 10 (38.5%) after more than 3 weeks (Group C). Patients in Group A did not develop complications, and 87.5% achieved a final visual acuity of 5/10 or better. In Group B, 4 patients (50%) developed moderate intraocular inflammation and 5 patients achieved a final visual acuity of 5/10 or better. Six patients in Group C (60%) had phacoanaphylactic glaucoma and 3 (30.0%), retinal detachment; 70.0% had a final visual acuity of 3/10 or worse. Conclusion Early vitrectomy (fewer than 3 weeks postoperatively) was associated with better visual results, while late vitrectomy resulted in limited visual acuity in a high percentage of patients and increased the risk for glaucoma and retinal detachment.