Outcome of vitrectomy for retained lens fragments after phacoemulsification

Purpose: To evaluate the incidence of complications and the visual outcome of pars plana vitrectomy in patients with retained lens fragments in the vitreous cavity after phacoemulsification. Methods: A retrospective chart review of 85 patients who underwent vitrectomy for removal of retained lens fragments at the Barnes Retinal Institute/Washington University Medical Center between 1990 and 1998. Results: At the time of presentation, uveitis (n = 57, 67.1%), increased intraocular pressure > 25 mmHg (n = 44, 51.8%), and corneal edema (n = 42, 49.4%) were frequently observed. The initial visual acuity was 20/200 or worse in 61 (71.8%) eyes. However, the final visual acuity after vitrectomy, with 10.1 months follow-up, was 20/40 or better in 44 (51.8%) eyes. The major complication observed was retinal detachment, which was present in seven (8.2%) eyes: four before vitrectomy and three after vitrectomy. Visual outcome after vitrectomy and cataract extraction was compared among three groups based on the timing of the second surgery: less than or equal to 7 days postcataract extraction; 8-30 days postcataract extraction; and > 30 days postcataract extraction. No statistically significant difference in final visual acuity was observed between the three intervals. Conclusions: The major complication associated with vitrectomy for retained lens fragments in the vitreous cavity after phacoemulsification was retinal detachment. The timing of vitrectomy did not affect the final visual acuity outcome. Visual prognosis was most closely related to the presence of age-related macular degeneration and cystoid macular edema. The type of intraocular lens did not influence the visual outcome. Management with vitrectomy yielded favorable visual results in most patients with retained lens fragments.