Retained Lens Fragments Research Articles

Management of dislocated lens material

Posterior dislocation of lens fragments is a well-known complication of phacoemulsification. Retained lens material in the vitreous cavity can lead to poor visual acuity related to inflammation, corneal edema, and glaucoma. Pars plana vitrectomy is frequently necessary to remove the dislocated lens fragments. The optimal timing of vitrectomy has not been firmly established. Several large studies have failed to establish an association between timing of vitrectomy and visual outcome. However, others suggest that earlier vitrectomy may lead to improved visual outcomes and lower rates of chronic glaucoma. Excellent outcomes are possible for patients undergoing vitrectomy for retained lens fragments. Retinal detachment is the most common cause of poor visual acuity in these patients. The risk of retinal detachment is correlated with vitreous manipulation by the cataract surgeon in attempts to retrieve dislocated lens material. Therefore, if both the anterior segment and vitreoretinal surgeons rigorously avoid vitreous traction in these cases, a good visual prognosis is expected.

Retained lens fragments after cataract surgery.

In conclusion, the incidence of retained lens fragments appears to have increased in recent years. The timing of vitrectomy can be delayed to permit improvement of corneal edema, ocular congestion, and acute postoperative inflammation. Placement of a posterior chamber intraocular lens at the time of the initial cataract surgery does not adversely affect final visual results. Retinal detachment is a frequent adverse event in these eyes. Vitrectomy and removal of retained lens fragments restores good visual acuity and reduces secondary glaucoma in the majority of patients.

Outcome of vitrectomy for retained lens fragments after phacoemulsification

PURPOSE: To evaluate the incidence of complications and the visual outcome of pars plana vitrectomy in patients with retained lens fragments in the vitreous cavity after phacoemulsification. METHODS: A retrospective chart review of 85 patients who underwent vitrectomy for removal of retained lens fragments at the Barnes Retinal Institute/Washington University Medical Center between 1990 and 1998. RESULTS: At the time of presentation, uveitis (n = 57, 67.1%), increased intraocular pressure >25 mmHg (n = 44, 51.8%), and corneal edema (n = 42, 49.4%) were frequently observed. The initial visual acuity was 20/200 or worse in 61 (71.8%) eyes. However, the final visual acuity after vitrectomy, with 10.1 months follow-up, was 20/40 or better in 44 (51.8%) eyes. The major complication observed was retinal detachment, which was present in seven (8.2%) eyes: four before vitrectomy and three after vitrectomy. Visual outcome after vitrectomy and cataract extraction was compared among three groups based on the timing of the second surgery: =7 days postcataract extraction; 8–30 days postcataract extraction; and >30 days postcataract extraction. No statistically significant difference in final visual acuity was observed between the three intervals. CONCLUSIONS: The major complication associated with vitrectomy for retained lens fragments in the vitreous cavity after phacoemulsification was retinal detachment. The timing of vitrectomy did not affect the final visual acuity outcome. Visual prognosis was most closely related to the presence of age-related macular degeneration and cystoid macular edema. The type of intraocular lens did not influence the visual outcome. Management with vitrectomy yielded favorable visual results in most patients with retained lens fragments.

Retained intravitreal lens fragments after phacoemulsification: a clinicopathological correlation

AIMSTo explore the relation between clinical course and timing of vitrectomy with the nature and intensity of intraocular inflammatory response in eyes with retained intravitreal lens fragments following complicated phacoemulsification.METHODSProspective...

Effects of Age, Sex, Cataract, and Cataract Surgery on Serum γ-Crystallin Concentration

Purpose: To determine if measurement of lens protein in serum is a feasible means to gain information on the physiologic status of the lens in human subjects. Methods: The γ-crystallin concentration was measured by a sandwich radioimmunoassay in the sera of 280 subjects aged 25–94 years. Medical records were reviewed for diagnoses of cataract and aphakia. Results: There was no effect of age or sex on the serum γ-crystallin concentration. There were 57 subjects with cataract and 27 with aphakia. γ-Crystallin was higher in all cataract groups and lower in aphakia. The mean γ-crystallin concentrations for selected subject groups were as follows: clear lens 301 pg/ml; pure nuclear cataract 344 pg/ml; pure cortical cataract 439 pg/ml and aphakia 255 pg/ml. Conclusions: This is the first published report to show that lens protein is measurable in serum and to demonstrate the feasibility of using serum assays of lens proteins to gain information on the physiological status of the lens. Our results confirm the hypothesis that molecular and cellular events leading to cataract cause increased leakiness of lens cell membranes with release of lens proteins appearing in the blood. It is conceivable that measurement of lens proteins in serum might find future use in the evaluation of cataract risk, potentially cataractogenic and anticataractogenic agents, retained lens fragments after phacoemulsification, secondary cataract, phacolytic glaucoma, anaphylactic endophthalmitis, eye injuries, and other eye diseases.

The management of dislocated lens material after phacoemulsification.

To determine the visual outcome, prognostic factors, and effect of timing of surgical intervention in patients with retained lens fragments after phacoemulsification. A retrospective review was carried out of the notes of 44 consecutive patients who suffered posterior dislocation of lens fragments during phacoemulsification, of whom 34 underwent vitrectomy. The presence of severe uveitis at presentation was a significant predictor of a final visual acuity of less than 6/60 (p = 0.002). A raised intraocular pressure at presentation (> 29 mmHg) significantly increased the risk of chronic glaucoma (p = 0.0279), but there was no association between glaucoma and delay in vitrectomy. Patients operated on within 1 week of cataract surgery obtained a better visual outcome (64.7%) of patients achieved 6/12 or better visual acuity) than those operated on later than 1 week (41% obtained 6/12), but this difference did not reach statistical significance. The trend towards a better visual outcome with early vitrectomy was not statistically significant. A large prospective trial is indicated to determine the optimum time for vitrectomy in these patients.

Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens.

To evaluate the advantages of vitrectomy combined with endoscopy for the management of retained lens fragments and/or posteriorly dislocated intraocular lens (IOL). A consecutive series of 30 eyes with these complications treated by this technique was reviewed retrospectively. An endoscopic probe which incorporates a video channel, a fibreoptic light source, and a diode laser was used for visualization. Lens material or the IOL was extracted through the corneal wound in 18 eyes (60%). They were either aspired or grasped or lifted using perfluorocarbon liquids (PFCL), under endoscopic control. In 9 eyes (30%) pars plana phakoemulsification was performed. PFCL was used in 11 eyes (36.6%). In 16 eyes (53.3%) an IOL was sutured in the ciliary sulcus. Final visual acuity was > or = 20/40 in 19 eyes (63.3%), > or = 20/30 in 15 eyes (50%). Intraoperative breaks occurred early in the series in two eyes (in one case from use of the endoprobe, in the other from pars plana phakoemulsification). Poor final acuity was related to proliferative vitreoretinopathy, which developed in both cases with an intraoperative iatrogenic retinal break, senile macular degeneration, myopia and amblyopia, cystoid macular oedema, corneal oedema and high astigmatism. We found that endoscopy facilitated the management of these complications of cataract surgery once the peculiar difficulties of the technique (absence of stereoscopy, manipulation of the endoprobe, video monitor control) were mastered. Endoscopy facilitated and shortened localization of lens fragments embedded into the vitreous base for aspiration, grasping and phakoemulsification, enabled detection of small anterior retinal breaks, permitted resection of adhesions between anterior hyaloid, lens capsule and ciliary sulcus and facilitated PFCL manipulations, whatever the status of the anterior segment (corneal edema, myosis, synechiae, presence of IOL).

Occurrence of retained lens fragments after phacoemulsification in The Netherlands

Purpose: To determine the incidence of retained lens fragments after phacoemulsification in The Netherlands and to evaluate the effect of vitrectomy on this complication.Setting: Eleven vitreoretinal centers in The Netherlands.Methods: We performed a retrospective analysis of all patients with retained lens fragments (N = 70) who were referred for vitreoretinal surgery to 11 specialized centers. Seven patients (10%) were treated with medication alone, and 63 (90%) had pars plana vitrectomy. Minimum follow-up after vitrectomy was 3 months.Results: The incidence of retained lens fragments in The Netherlands was calculated at 0.9/1000 cataract operations. Retained lens fragments occurred during the learning curve and with experienced surgeons. After medical or surgical treatment, visual acuity was 20/40 or better in 43 of 70 patients (61%). Uveitis disappeared in all cases. Retinal detachment occurred in 10 patients (14%). Attached retinal breaks were treated in an additional 5 patients. Corneal grafting was performed in 2 patients. Patients who had immediate vitrectomy did not have better functional results than patients in whom vitrectomy was delayed. The iris-fixated claw lens was implanted successfully when capsular support was insufficient.Conclusions: The introduction of phacoemulsification in The Netherlands is associated with an increase of patients with retained lens fragments. Retained lens fragments are complicated by an increased risk for retinal detachment and corneal decompensation. Vitrectomy resulted in a marked improvement of visual acuity and clearing of uveitis.

Vitrectomy for Retained Lens Fragments after Phacoemulsification

Posterior lens fragments after phacoemulsification can be a serious complication of cataract surgery. This study is designed to evaluate the clinical features of eyes after pars plana vitrectomy has been performed to remove posteriorly dislocated lens fragments after phacoemulsification. The authors performed a retrospective chart review of 126 consecutive eyes of 126 patients with dislocated lens fragments after phacoemulsification, managed with pars plana vitrectomy at Associated Retinal Consultants of Michigan. These eyes were operated on from January 1986 through January 1996. The relation of the intervals between cataract surgery and vitrectomy to various postoperative clinical parameters was studied. Clinical features at presentation included elevated intraocular pressure (IOP over 25 mmHg) in 52.4% of the eyes, uveitis in 69.6%, and corneal edema in 50.8%. Initial visual acuity was 20/400 or worse in 73.8% of the eyes. The mean preoperative visual acuity was 20/278 (median, 20/400), whereas the mean final visual acuity was 20/40 (median, 20/50) after a mean follow-up of 18.9 months. Retinal detachments were found in 20 eyes: 7 before vitrectomy and 13 during or after it. After surgery, 44% of eyes achieved a final visual acuity of 20/40 or better and 90% were 20/400 or better. The distribution of best-corrected final visual acuities among the eyes showed statistically significant differences based on the type of intraocular lens (IOL) used, with posterior chamber IOL greater than anterior chamber IOL, and anterior chamber IOL greater than aphakia. Reasons for a poor visual outcome included persistent corneal edema (four eyes), retinal detachment (two eyes), central retinal vein occlusion (two eyes), age-related macular degeneration (two eyes) glaucoma (one year), and endophthalmitis (one eye). There were no statistically significant differences between early (< 7 days) and delayed (8 days or more) vitrectomy when increased IOP, corneal edema, choroidal effusions, cystoid macular edema, and visual acuity were analyzed. The use of vitrectomy to remove posteriorly dislocated lens fragments has been shown to be an effective treatment method that significantly reduces the inflammatory response and hastens visual recovery.

Removal of Retained Lens Fragments after Phacoemulsification Reverses Secondary Glaucoma and Restores Visual Acuity

The purpose of the study is to evaluate the effect of vitrectomy on secondary glaucoma and visual acuity outcomes in patients with retained lens fragments after phacoemulsification. A retrospective analysis of 126 patients who had vitrectomy for retained lens fragments after phacoemulsification during the 3-year period between January 1, 1993, and December 31, 1995. Glaucoma, defined as an intraocular pressure of greater than or equal to 30 mmHg, occurred in 42 (36.8%) of 114 patients before vitrectomy and in 4 patients (3.2%) of 126 after vitrectomy. There were no differences in the rates of persistent glaucoma regardless of the intervals between cataract surgery and the vitrectomy: less than or equal to 1 week, 2 patients (4.1%); greater than 1 week to less than or equal to 4 weeks, 1 patient (2.5%) and greater than 4 weeks, 1 patient (2.6%). The visual acuity was 20/40 or better in 13 patients (11.4%) before vitrectomy and in 75 patients (59.5%) after vitrectomy. The rates of visual acuity 20/40 or better also were similar for all intervals: less than or equal to 1 week, 29 patients (59.2%); greater than 1 week to less than or equal to 4 weeks, 22 patients (56.4%) and greater than 4 weeks, 24 patients (63.1%). Vitrectomy for removal of retained lens fragments reduces secondary glaucoma and yields favorable visual acuity outcomes. In eyes with elevated intraocular pressure, early vitrectomy generally is recommended, but delayed vitrectomy also has favorable outcomes.

Retinal Detachment in Patients With Retained Lens Fragments or Dislocated Posterior Chamber Intraocular Lenses

Retinal detachment is a complication of dislocated crystalline and intraocular lenses. The purpose of this study was to compare the frequency and management of coexisting or subsequent retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses (PC IOLs). A retrospective, consecutive series of patients undergoing vitrectomy for dislocated PC IOLs (99 eyes) or removal of retained lens material (80 eyes) were studied. Eyes with retinal detachment and retained lens fragments (2 cases) or dislocated PC IOLs (2 cases), or retinal detachment following vitrectomy for removal of retained lens fragments (2 cases) or repair of dislocated IOL (1 cases) were identified. The prevalence of coexisting or postoperative retinal detachment and retained lens fragments (5% total) was slightly higher than the prevalence of coexisting or postoperative retinal detachment and dislocated PC IOLs (3% total). The retina was reattached in all cases using the standard scleral buckling and vitrectomy techniques. The rate of retinal detachment associated with retained lens material is decreased compared with previous reports. This may possibly be a results of increasing attention to minimizing surgical trauma by the cataract surgeon at the time of lens fragment loss and by the vitrectomy surgeon during primary repair.

Outcomes of Vitrectomy for Retained Lens Fragments

Purpose: Retained lens fragments after cataract surgery is an infrequent, but potentially serious surgical complication. The aim of this study is to evaluate outcomes after vitrectomy has been performed for removal of retained lens material.Methods: A retrospective review was conducted to evaluate all cases of pars plana vitrectomy for removal of retained lens fragments performed at Wills Eye Hospital from April 1991 through August 1994.Results: A total of 121 eyes of 121 patients underwent pars plana vitrectomy with removal of retained lens material over the 3 1/2-year period. Visual acuity on presentation was 20/200 or worse in 95 eyes (79%). Visual acuity after vitrectomy was 20/40 or better in 82 eyes (68%). The postoperative visual acuity was 20/50 to 20/400 in 21 eyes (17%), and counting fingers or worse in 18 eyes (15%). Nineteen eyes (16%) had retinal detachment (RD): 8 were noted at the time of vitrectomy and 11 occurred after vitrectomy. Of the 19 eyes with RD, visual acuity was 20/200 or worse in 12 (63%) and counting fingers or worse in 6 (32%) at the time of last follow-up. The use of posterior segment phacofragmentation was associated with higher rate of RD, but the difference did not reach statistical significance. Major causes of poor final visual outcome included RD (6 eyes), cystoid macular edema (4 eyes), and glaucoma (2 eyes).Conclusion: The timing of vitrectomy did not have a statistically significant impact on visual outcome. Neither the type of intraocular lens nor the timing of lens implantation significantly altered the final visual acuity. Most eyes with retained lens fragments do well after vitrectomy, with the majority recovering good vision. However, the risk of RD is increased, and visual outcome may be adversely affected if RD occurs.

Endophthalmitis in Patients with Retained Lens Fragments after Phacoemulsification

To review the treatment and outcomes of patients presenting with concurrent endophthalmitis and retained lens fragments after phacoemulsification. A retrospective chart review was conducted on patients presenting with culture-proven endophthalmitis and retained lens fragments after phacoemulsification between 1990 and 1994. Five patients were identified with culture-proven endophthalmitis and retained lens fragments after phacoemulsification. In all patients, coagulase-negative staphylococci were cultured from the vitreous fluid. One patient also had positive cultures for Proteus mirabilis and Escherichia coli. The interval between cataract surgery and treatment ranged from 5 days to 6 months. Echography was beneficial in showing retained lens fragments in five of five patients when media opacities obscured the view of the fundus. Four patients had vitrectomy and removal of retained lens fragments during their initial treatment. The fifth patient was treated with intravitreal antibiotics alone and continued to have marked inflammation, eventually requiring vitrectomy for removal of the retained lens fragments. A final visual acuity of 20/400 or better was achieved in four of the five patients. Patients may present with endophthalmitis in the setting of retained lens fragments after phacoemulsification. In such cases, the preferred initial management may be pars plana vitrectomy, removal of retained lens fragments, and injection of intraocular antibiotics. In eyes with endophthalmitis and opaque media, echography is a useful screening modality.

Retained Lens Fragments after Phacoemulsification

The authors present the clinical features of patients with retained lens fragments after phacoemulsification and their outcome after pars plana vitrectomy. The authors performed a retrospective chart review of 62 patients who had surgical management of posteriorly dislocated lens fragments after phacoemulsification during the 3-year period from January 1990 to December 1992. Eight of the 62 patients underwent vitrectomy on the same day as the cataract surgery. Of the remaining 54 patients examined in the outpatient clinic, initial clinical features included marked intraocular inflammation (87%), elevated intraocular pressure of 30 mmHg or higher (46%), and corneal edema (46%). Retinal detachment was present before vitrectomy in one patient and occurred after vitrectomy in two others. Initial visual acuity was 20/200 or worse in 68% of patients. After vitrectomy, final visual acuity was 20/40 or better in 68% of patients. Using the percentage of patients with 20/40 or better final visual acuity, there was no statistically significant difference in surgery performed within 7 days (70%), between 1 and 4 weeks (60%), and after 4 weeks (70%). Twenty (80%) of 25 patients with initial posterior chamber intraocular lenses (PC IOLs) and 16 (62%) of 26 patients with initial anterior chamber IOLs (AC IOLs) achieved 20/40 or better visual acuity. A visual acuity outcome of 20/200 or worse occurred in all three patients with retinal detachment. Six of the eight patients who underwent vitrectomy on the same day as the cataract surgery achieved 20/30 or better visual acuity. The timing of vitrectomy did not influence visual acuity outcomes. Intraocular lenses inserted at the primary operation did not adversely affect the visual outcome. However, vitrectomy on the same day as cataract surgery generally yielded favorable visual acuity outcomes and eliminated the need for a second operation at a later date. In most patients with retained lens fragments, management with vitrectomy allowed good visual acuity outcomes.

Retained Lens Fragments After Phacoemulsification Manifesting as Marked Intraocular Inflammation With Hypopyon

We reviewed the medical records of four patients with marked intraocular inflammation and hypopyon as the initial manifestation of retained lens fragments after phacoemulsification. The severe inflammatory reaction occurred between one month and one year after the cataract extraction. All four patients underwent pars plana vitrectomy to remove the lens fragments. The vitreous specimens were cultured to rule out infectious endophthalmitis. In all patients, no organisms were isolated from the vitrectomy specimens placed on both aerobic and anaerobic media. All patients had improved vision and resolution of the marked intraocular inflammation after vitrectomy. Echography was useful in establishing the diagnosis in these uncommon cases.

Retained Intravitreal Lens Fragments after Cataract Surgery

The purpose of this study is to review the possible benefits and complications of vitrectomy for retained lens fragments after cataract surgery. The authors reviewed the charts of 65 patients referred over a 12-year period for retained lens fragments after cataract surgery. Of these, 56 underwent vitrectomy and 9 were followed. Of these 56 eyes, 29 (52%) had received an intraocular lens (IOL) at the time of cataract surgery. Resulting complications from retained lens material included glaucoma (52%), corneal edema (46%), uveitis (56%), and decreased vision (100%). These sequelae responded equally to vitrectomy in eyes with or without an IOL and irrespective of type of cataract surgery (phacoemulsification or extracapsular cataract extraction). The timing of surgery did not statistically influence the final vision or the incidence of glaucoma. Removal of retained lens fragments allows rapid visual restoration, enhances resolution of uveitis, and improves control of glaucoma. Insertion of an IOL at the time of cataract surgery in the face of dislocated lens fragments is not contraindicated provided that it could be performed safely.