Program list

Dropped nucleus

Gunnar Jakobsson

Gothenburg/Molndal, Sweden

Dropped nucleus - defined as loss of a part or the whole lens nucleus to the vitreous cavity -
is an unusual but well known complication during modern cataract phaco-technique surgery. Most cases need re-operation with pars plana vitrectomy (ppv) in order to avoid serious complications and damage to the eye due to secondary glaucoma, prolonged intraoccular inflammation or retinal detachment.
Methods: All patients who underwent ppv because of dropped nucleus at Sahlgren University Hospital during three years (1998,1999,2000) were studied retrospectively.
Results: 44 patients from in total twelve different referring eye-clinics in the Western region of Sweden were studied. The incidence was about 1,4 per 1000 cataract-operations.
Twenty-five ophthalmic surgeons were represented and only two of these were residents.
45% of the patients got an intraoccular lens (IOL) at the time of the cataract-procedure and an anterior vitrectomy was performed in 60 % of the cases.
55% of the patients had an intraoccular pressure-rise to 40-mm Hg or more after the cataractoperation and this was most often seen the first day postoperatively. Re-operation using ppv and removal of nucleus and cortex remnants with fragmentation-technique was performed within two weeks in 41% and 2-5 weeks in 32% of the patients. Secondary IOL-implantation was performed in 48% of the patients, which means that three eyes out of totally 44 were left aphakic. At follow-up at in average 6 months, about 60% had a visual
acuity of 0,5 or better and 10 % of the patients had 0,2 or worse. Non of the patients had developed glaucoma and those who had glaucoma pre-operatively were well controlled. No case of retinal detachment was observed. Two patients had cystoid macular oedema and one had long-standing corneal oedema.
Conclusions: Dropped nucleus during cataract surgery in most cases does not lead to any serious complication predicted it is handled correctly during the first cataract-operation and is re-operated in a later secondary procedure using pars plana vitrectomy and removal of lens material. High intraoccular pressure is common especially the first day postoperatively. Severe complications as retinal detachment or chronic glaucoma were not observed in our group of patients.