SURGICAL APPROACH FOR RETAINED LENS MATERIALS AFTER CATARACT EXTRACTION.

Cataract surgery is the most frequently performed surgical procedure in the world, with an estimated 19–20 million surgeries done annually. While the risk of intraoperative complications related to cataract surgery is quite low with modern surgical approaches and technology, it does exist. One such complication is posterior capsule rupture with “dropped” lens particles into the vitreous cavity. Furthermore, this complication often requires a subsequent pars plana vitrectomy with lens fragment retrieval or pars plana lensectomy (collectively referred to as PPV from this point forward), although some cases can be managed medically.

National Ophthalmology Center named after academician Zarifa Aliyeva, Baku, Azerbaijan.

We performed a retrospective analysis of 10 patients (10 eyes) who underwent cataract extraction with posterior capsule rupture with dropped lens fragments into vitreous cavity previously. All patients had posterior capsule rupture and dropped lens materials into vitreous cavity. Patients were divided into 3 groups. First group was medical treatment group which 3 patient’s 3 eyes with retained lens materials was treated with medical treatment. Second and third groups included 7 patients’ 7 eyes performed in 3 patients 3eyes early and in 4 patients 4 eyes late pars plana vitrectomy surgery.

According on the results of the research we conducted in 10 eyes of 10 patients over a period of 1.5 year. The complications were from different surgeons.The study evaluated 10 patients which performed 3 early surgery, 4 late surgery, and 3 medical therapy.Early surgery performed from immediate after complication till 7days period. Late surgery performed from 2 weeks till 3 month. It seems that in late surgery group vision acuity outcomes can be lower than early surgery group.Late surgery group  BCVA~6/15; early surgery group BCVA~6/10 respectively.  It is also depends on patient’s strict inflammation, and IOP control. Medical therapy group vision acuity is better than surgery groups-BCVA~6/7.5. I also want to mention that in our medical therapy group retained fragments were just small epinucleus fragments.

Medical management with topical corticosteroids or observation may be considered for small lens fragments, but surgical removal remains the mainstay of the treatment for large lens fragments. Medical management can be performed in controlled inflammation and IOP patients. If we have high uncontrolled IOP and inflammation we should immediately perform pars plana vitrectomy.