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Vitreoretinal surgeons should handle dropped nucleus cases, expert says
 Ferenc Kuhn |
LONDON — A dropped nucleus requires prompt intervention, expert hands and complete vitrectomy, according to a speaker here.
"No messing about with lasso instruments to try and rescue the fragments from the vitreous, unless they are few and very superficial. Remnants would lead to inflammation and its consequences, such as [cystoid macular edema] and retinal detachment," Ferenc Kuhn, MD, said at the Euretina meeting.
Complete pars plana vitrectomy should be performed by a trained vitreoretinal surgeon as soon as possible to eliminate the source of inflammation and spare the patient the anxiety of a second procedure, Dr. Kuhn said.
"The only reason for delaying surgery is logistic: The vitreoretinal specialist is not available at the time of cataract surgery or the facility is not equipped to do vitrectomy," he said.
Vitrectomy should be complete and include detachment and removal of the posterior cortical vitreous.
"Preferably, it should be done before nucleus removal. If the nucleus is not too hard, it can be crashed between the light pipe and the vitrectomy probe and then removed with the vitrectomy probe. Performing a 360° laser retinopexy at the end of surgery has reduced my retinal detachment rate from 8% to 2%," he said.
- Disclosure: Dr. Kuhn has no relevant financial disclosures.