Pars plana vitrectomy and pars plana lensectomy for retained lens fragments

Abstract

While cataract extraction surgery has become increasingly safe and efficient, retained lens material or a "dropped nucleus" continues to be one of the more common complications, typically as a result of posterior capsule compromise or zonular dehiscence. An attempt to remove posteriorly dislocated lens material by the anterior segment surgeon is often attempted via an anterior vitrectomy but may result in anterior vitreous traction leading to retinal tears and possibly detachment. While small cortical lens fragments may be well tolerated and eventually absorbed, persistent retained lens material places the eye at risk for elevated intraocular pressure, chronic inflammation predisposing to cystoid macular edema and corneal edema, and retinal detachment. Although some authorities advocate for prompt lens removal, the definitive timing to posterior segment intervention is not universally agreed upon. Depending on the hardness of the lens, its removal may be achieved with the vitrectomy handpiece alone or in combination with fragmatome phacoemulsification. Surgical outcomes are typically favorable with the majority of patients retaining 20/40 vision or better [1].