This article is more than 5 years old. Information may no longer be current.
Retained lens fragments after phaco may be managed with medication
J Cataract Refract Surg. 2009;35(5):863-867.
Click Here to Manage Email Alerts
Prudent medical management may delay surgery without adverse events in some patients with retained crystalline lens fragments after phacoemulsification.
“Based on our results, it seems reasonable to manage patients with retained lens fragments with pressure-lowering and anti-inflammatory medications,” the study authors said. “If there is no improvement, vitrectomy for the removal of lens fragments should be considered. In cases with markedly elevated IOP of severe inflammation refractory to medical management, more urgent surgical intervention might be indicated.”
The retrospective study included 42 patients with lens fragments dislocated into the vitreous cavity. Twelve patients underwent pars plana vitrectomy and removal of lens fragments within 1 week after cataract surgery. Fifteen patients received anti-inflammatory and ocular hypotensive agents for 2 weeks but had to undergo pars plana vitrectomy because of persistent inflammation, diminished visual acuity or uncontrolled IOP. Fifteen patients underwent conservative medical therapy alone.
Follow-up examinations were conducted at 7, 14 and 30 days, and 1 year postop.
The early and late surgery groups had markedly lower visual acuity than the medical therapy group in the 2 weeks after cataract surgery. However, all three groups had similar visual acuity at 30 days postop. Also, all three groups had significantly improved visual acuity at 1 year; there were no statistically significant differences between groups, the authors said.
This recently published paper by Schaal and Barr shows that not all cases of retained lens material (RLM) need vitrectomy surgery. Good outcomes are possible with medical management alone. However, caution should be exercised in interpreting these results. First, there is no study published to date, including this one, that indicates precisely what types of cases should have vitrectomy and when it should be performed. Most agree that eyes with RLM that have severe inflammation, uncontrolled elevated IOP and retinal problems usually require vitrectomy. Although the ideal timing is not known, urgent surgery is not necessary in most cases. Second, even though eyes in all groups had similar final outcomes, there was a trend toward better final visual acuity (20/25) in the group having early vitrectomy (less than 1 week) compared with the group without vitrectomy (20/38). Lastly, everyone involved in these cases should keep in mind that the overall visual outcomes published in series such as this one continue to be relatively poor with only 65% of eyes achieving a final visual acuity of 20/40 or better. Therefore, like with many other conditions in medicine, prevention is the best strategy.
– Carl D. Regillo, MD
OSN Retina/Vitreous
Board Member