Management of dislocated lens material

Abstract

Posterior dislocation of lens fragments is a well-known complication of phacoemulsification. Retained lens material in the vitreous cavity can lead to poor visual acuity related to inflammation, corneal edema, and glaucoma. Pars plana vitrectomy is frequently necessary to remove the dislocated lens fragments. The optimal timing of vitrectomy has not been firmly established. Several large studies have failed to establish an association between timing of vitrectomy and visual outcome. However, others suggest that earlier vitrectomy may lead to improved visual outcomes and lower rates of chronic glaucoma. Excellent outcomes are possible for patients undergoing vitrectomy for retained lens fragments. Retinal detachment is the most common cause of poor visual acuity in these patients. The risk of retinal detachment is correlated with vitreous manipulation by the cataract surgeon in attempts to retrieve dislocated lens material. Therefore, if both the anterior segment and vitreoretinal surgeons rigorously avoid vitreous traction in these cases, a good visual prognosis is expected.