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Management of dislocated nuclear fragments after cataract surgery- timing

M Stefaniotou, E. Christodoulou, M. Aspiotis, Chr. Pappa, K. Psilas

Ioannina, Greece

Purpose : To determine the timing of vitrectomy in patients with dislocated nuclear fragments following phacoemulsification surgery and to correlate timing with the visual outcome.
Methods : We performed a retrospective review of the records of 26 patients (13 men and 13 women), age range 59 to 80 years (mean age 66,9 years), who were operated in the University Eye Clinic of Ioannina from 1-1-1996 to 1-3-2002. All the patients had nucleus or nuclear fragments dislocation into the vitreous cavity during phacoemulsification and underwent vitrectomy and removal of dislocated nucleus. The follow up period ranged from 3 to 9 months postoperatively.
Results : Eight patients (30,77%) underwent immediate vitrectomy at the time of phacoemulsification (group A), 8 patients (30,77%) underwent vitrectomy within 3 weeks (group B) and 10 patients (38,5%) had vitrectomy performed more than 3 weeks (group C). Patients of group A did not develop any complications and 87,5% of them achieved 5/10 or better visual acuity. Moderate intraocular inflammation was recorded in 4 patients (50%) of group B, while 5 patients obtained 5/10 or better final visual acuity. Six patients of group C (60%) had phacoanaphylactic glaucoma while 3 (30%) presented retinal detachment, 70% had 3/10 or less final visual acuity.
Conclusion : It appears that early vitrectomy (<3 weeks) is associated with better visual results, while late vitrectomy results in limited visual acuity in a large number of patients and increases the risk of glaucoma and retinal detachment.