COMMENTARY

Removing Retained Lens Fragments: Now or Later?

William W. Culbertson, MD

Disclosures

November 13, 2013

Retained Lens Fragments After Cataract Surgery: Outcomes of Same-Day Versus Later Pars Plana Vitrectomy

Modi YS, Epstein A, Smiddy WE, Murray TG, Feuer W, Flynn HW Jr
Am J Ophthalmol. 2013;156:454-459

Remove Retained Lens Now or Later?

Lens fragments, or even the entire lens, can become displaced into the vitreous cavity during the course of cataract surgery, as a consequence of a break in the posterior capsule or a loss of the intact peripheral zonular barrier. Although this complication is usually apparent during surgery, retained lens material may not be recognized for days or weeks after surgery.

When lens material begins to drop into the vitreous cavity, attempts by the anterior segment surgeon to retrieve it may lead to further complications, such as giant retinal tears and retinal detachment. If the cataract surgeon does not have expertise with pars plana vitrectomy (PPV), it has been recommended that the surgeon complete the remainder of the procedure, including placement of the intraocular lens, and allow a vitreoretinal specialist to remove the lens material, if necessary, at a future date.

Small amounts of cortical material can often safely be allowed to absorb spontaneously without additional intervention. Retention of larger fragments of cortical or nuclear lens material may lead to vitritis, uveitis, glaucoma, macular edema, or other vitreoretinal complications.

This study examined the medical benefit of surgically removing the retained lens material by pars plana vitrectomy on the same day as the original cataract surgery compared with removal, for instance, by a vitrectomy surgeon at another location on another day.

Study Summary

This retrospective study compared best-corrected visual acuity (BCVA) after PPV at the Bascom Palmer Eye Institute for removal of retained lens fragments in 569 eyes over a 22-year period, from 1990 to 2011, in 3 groups: on the same day as cataract surgery (117 eyes; 22%), or 1 week (131 eyes; 23%) and more than 1 week (321 eyes; 57%) after cataract surgery. The same-day cases took place consecutively at the Bascom Palmer Eye Institute in the same room as the cataract surgery, whereas the "1 week" and "more than 1 week" cases were generally referred from outside surgeons.

Similar visual outcomes and complication rates were recorded for all 3 groups regardless of whether they had had immediate or later PPV surgery. There were no differences in BCVA among the different groups, with approximately 60% (56%-63%) overall attaining 20/40 or better BCVA. Complication rates were statistically similar, including the incidence of cystoid macula edema (22%-28%), glaucoma (4%-5%), and retinal detachment (4%-11%; average, 9%).

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