Vitreoretinal surgery for retained lens fragments after phacoemulsification.

Objective: To evaluate the prognostic factors, effect of timing and outcomes of vitreoretinal surgery for removal of retained lens fragments after phacoemulsification.

Methods: A retrospective review of 43 eyes of 43 patients who had vitreoretinal surgery for retained lens fragments after phacoemulsification, between January 1998 and November 2000.

Results: Seven of the 43 patients underwent vitrectomy on the same day as cataract surgery, 20 in the first week, and 23 after the first week, with a mean of 14.8 days (0-90). Initial visual acuity was < or = 20/400 in 27 (75%, n=36) and intraocular pressure (IOP) > or = 25 mmHg in 22 (61%, n=36) eyes with or without medication. The mean preoperative IOP was 27.4 mmHg. Initial ocular findings included moderate or severe corneal edema in 17 patients (40%), uveitis in 14 (33%), retinal detachment in 1 (2%) and vitreous hemorrhage in 2 (5%). After a mean follow-up of 8.4 months, final best-corrected visual acuity (BCVA) was > or = 20/40 in 24 patients (56%) and < or = 20/400 in 7 (16%). Persistent corneal edema (one eye), cystoid macular edema (four eyes), age-related macular degeneration (one eye) and suprachoroidal hemorrhage (one eye) were the causes of BCVA < or = 20/400. Final mean IOP was 15.2 mmHg and only one case had IOP > 25 mmHg. Uveitis disappeared in all cases (p<0.001), and corneal edema persisted in only one eye. Both the BCVA and IOP differences were significant (p<0.001), but no correlation was found between pre- and postoperative BCVA and IOP as regards vitreoretinal surgery timing, posterior or anterior removal sites and IOL implantation sites or procedures.

Conclusions: Vitreoretinal surgery is effective for removing retained lens fragments after phacoemulsification, lowering the IOP and reducing the uveitic reaction and corneal edema. BCVA > or = 20/40 can be reached in at least half the patients.