Intravitreal phacoemulsification with pars plana vitrectomy for management of posteriorly dislocated nucleus or lens fragments.

PURPOSE: Dislocation of crystalline lens nucleus/fragments into the vitreous cavity during phacoemulsification is a potentially serious, sight-threatening, uncommon complication of cataract surgery. It is associated with significant intraocular inflammation and can lead to poor visual outcome. The current study assesses the outcome of immediate intravitreal phacoemulsification with pars plana vitrectomy in management of posteriorly dislocated nucleus/lens fragments.

METHODS: In this retrospective case series, records of 23 patients who underwent immediate pars plana vitrectomy and intravitreal phacoemulsification for removal of dislocated nucleus/lens fragments at the same sitting of phacoemulsification were reviewed. Data including patients' preoperative and postoperative vision and intraoperative and postoperative complications were recorded.

RESULTS: The mean follow-up period was 16.5 months (range, 5-31 months). Preoperative visual acuity ranged from 0.05 to 0.5. The final postoperative visual acuity ranged between HM and 1.0. Fifty-two percent of eyes (12 eyes) had a final postoperative visual acuity of 0.5 or better. Complications included 2 cases of cystoid macular edema and 2 cases of retinal detachment.

CONCLUSIONS: Immediate vitrectomy and intravitreal phacoemulsification is a surgical option in the management of posteriorly dislocated nucleus/lens fragments without much risk of retinal damage. It is relatively safe and most patients achieved a good visual outcome. The risk of postoperative complications including uveitis, secondary glaucoma, and cystoid macular edema could be minimized.