Removing Retained Lens Fragments: Now or Later?

William W. Culbertson, MD


November 13, 2013


In most cataract surgical settings, there is no experienced PPV subspecialist readily available to come into the operating room and bail out the cataract surgeon. So it makes sense that the surgeon would refer the patient with retained lens material to a vitreoretinal colleague for timely PPV surgery days or weeks later. Although this requirement for a second surgery is upsetting and inconvenient for the patient, it is probably least disruptive when it can be done on a nonurgent basis by electively scheduling the patient for PPV surgery.

When the lens fragment is small, the cataract surgeon can elect to wait and see whether the fragment will absorb spontaneously without resorting to PPV surgery. However, in a situation in which a vitrectomy surgeon is available to come into the room to perform the lens fragment removal surgery, that is surely more convenient for the patient and his or her family.

This study demonstrates that in patients who need lens fragment removal via PPV, there is no difference in measurable outcomes regardless of whether they have the surgery on the same day or weeks later. It appears to be safe for a surgeon who experiences a loss of lens material into the vitreous cavity during cataract surgery to place the intraocular lens within the eye, if possible, and suture the incisions closed, with the plan to refer the patient within a few days to a vitreoretinal colleague. Attempts by the cataract surgeon to "levitate" the lens into the anterior chamber are less controlled and probably not necessary, given the results of this study.



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