Visual outcome after management of a posteriorly dislocated lens nucleus during phacoemulsification

Purpose: To evaluate the characteristics of eyes with a posteriorly dislocated lens nucleus during phacoemulsification and to assess the results of the management. Setting: Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan. Methods: Fifteen eyes (15 patients) with posteriorly dislocated lens nuclei during phacoemulsification were evaluated retrospectively. Patients ranged in age from 56 to 86 years old (mean 73.9 years +/- 9.6 [SD]). Thirteen of the 15 eyes had advanced cataract with hard nucleus before surgery. Three patients developed secondary glaucoma resulting from the lens particle after nuclear dislocation. Results: One dislocated lens nucleus was not removed surgically and only observed. In three patients, an attempt had been made to remove the dislocated lens nucleus at the time of cataract surgery. This caused massive choroidal hemorrhage with giant retinal tear, posterior retinal tear, and ora tear, respectively. Finally, the displaced nucleus was removed in 14 patients who had a pars plana vitrectomy at the time of cataract surgery (4 eyes) or a secondary procedure (10 eyes). In 5 eyes, liquid perfluorocarbon was used for the procedure. An intraocular lens (IOL) was successfully implanted in all eyes that were expected to have IOL implantation before surgery except in 1 eye with choroidal hemorrhage. Conclusion: Although the results of secondary management of displaced lens nucleus were fairly good, surgeons should take great care to avoid serious secondary complications such as retinal detachment and massive choroidal hemorrhage.