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Abstract
The aim of this study was to assess the visual outcome after management of posteriorly dislocated lens fragments during phacoemulsification. Thirty cases complicated by posterior dislocation of lens fragments during phacoemulsification cataract surgery were included in this study. These cases were divided into 2 groups; Group A: vitrectomized eyes who underwent vitrectomy with or without phacofragmentation, and Group B: non-vitrectomized eyes who were managed conservatively.
The conservative management consists of steroids, antibiotics, cycloplegics and antiglucoma medications. They were followed up daily for slit lamp examination, IOP measurement, visual acuity testing, and fundus examination.
Indications for vitrectomy were size of lens fragments larger than 25% associated with severe intraocular inflammation and increased IOP not controlled with steroids and anti-glaucoma medications within one week.
Parameters as determinants of visual outcome were analyzed. These parameters included performance of adequate anterior vitrectomy, IOL status, increased IOP, presence of retinal detachment, timing of vitrectomy, use of PFCL, use of phacofragmentation, and presence of preexisting eye disease.
Among Group A, 3, 4, and 7 eyes had intravitreal lens fragments less than 25%, 25% to 50%, and more than 50% of the lens volume, respectively while among Group B, 10, 6 had intravitreal lens fragments less than 25%, 25% to 50% of the lens volume, respectively.
Among Group A, 10, 2, and 2 eyes had PCIOL, ACIOL or no IOL, respectively. After vitrectomy, PCIOL was implanted in the two aphakic eyes, in which there was remnant of the posterior capsule. Better visual acuity was achieved in cases with PCIOL but the difference in visual acuity was not statistically significant. While among Group B, 12 and 4 eyes had PCIOL and ACIOL, respectively. Better visual acuity was achieved in cases with PCIOL but the difference in visual acuity was not statistically significant. Among Group A, uncontrolled elevated IOP (>25 mmhg with medications) was detected in 9 of 14 eyes before vitrectomy. One week and one month after vitrectomy, one eye still had uncontrolled elevated IOP. Two eyes required antiglaucoma medication at 1 and 2 month to maintain IOP within the normal range. Among Group B, uncontrolled elevated IOP was detected in 2 of 16 eyes. One week, one month and 2 months after phacoemulsification, one eye still had uncontrolled elevated IOP while the other eye required antiglaucoma medication to maintain IOP within the normal range.