Management of dislocated lens fragments after phacoemulsification surgery

Objective: To describe the management and visual outcome of patients with dislocated nuclear lens fragments. Design: Case series. Setting: Retina service at a university-affiliated hospital in Vancouver. Patients: Fifty-four consecutive patients (28 men and 26 women) with retained lens fragments following phacoemulsification surgery referred for management from May 1990 to May 1994. The patients' ages ranged from 41 to 94 (average 74) years. Results: Initial ocular findings in 52 patients included moderate or severe corneal edema in 23 cases (44%), intraocular pressure greater than 25 mm Hg in 24 (46%), intraocular inflammation in 36 (69%), retinal detachment in 2 (4%) and vitreous hemorrhage in 4 (8%). Of the eight patients managed conservatively with medical therapy six (75%) regained 20/40 or better vision. The remaining 46 patients underwent pars plana vitrectomy. The final visual acuity in this group was 20/40 or better in 30 patients (65%), 20/50 to 20/100 in 8 (17%) and 20/200 or worse in 8 (17%). Patients who had an anterior chamber intraocular lens (IOL) implanted at cataract surgery had a significantly poorer visual outcome than those who received a posterior chamber IOL at vitrectomy (I, = 0.03). Conclusions: When a significant segment of nucleus has dislocated during phacoemulsification surgery, vigorous irrigation or direct attempts to remove the lens fragments should be avoided, Anterior vitrectomy should be performed, and if adequate capsular support remains, a posterior chamber IOL should be inserted into the ciliary sulcus.