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Harry Krishna R. Roux, Minhee Cho, Robison V. Chan; 23-Gauge Pars Plana Vitrectomy for the Management of Posteriorly Dislocated Crystalline Lens. Invest. Ophthalmol. Vis. Sci. 2011;52(14):555.
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Management of posteriorly dislocated crystalline lens has traditionally been performed with a standard 20-gauge vitrectomy system. Over the years, micro-incision sutureless vitrectomies using 23- or 25-gauge systems have gained popularity. Here we demonstrate the use of a 23-gauge vitrectomy system for removal of retained lens fragments secondary to spontaneous dislocation or complicated cataract extraction.
This is a retrospective chart review of 14 eyes of 14 consecutive patients undergoing 23-gauge pars plana vitrectomy (PPV) and lensectomy for removal of dislocated lens. Pertinent demographic, medical and ocular information were collected. Visual outcomes and complication rates were examined.
Fourteen eyes of 9 women and 5 men underwent a 23-gauge vitrectomy for removal of retained lens. Mean age was 75 years. Mean pre-operative snellen visual acuity was 1.4 (Snellen equivalent 20/500, range 20/100 to Hand Motion). Mean post-operative snellen visual acuity was 0.33 (Snellen equivalent 20/43, range 20/20 to 20/150). 20-gauge fragmatome was used in 64% of cases. Suturing of one or more sclerotomies was performed in 86% of cases. The mean time to the best post-PPV acuity was 4.9 weeks. The mean healing time was 25 days (range 6 to 48). Post-vitrectomy complications included choroidal detachment (2 patients), vitreous hemorrhage (2 patients), progression of diabetic macular edema (2 patients) and ocular hypertension (2 patients). Patients were followed for a mean of 6.2 months (range 1 to 13 months).
23-gauge vitrectomy system alone or in combination with the 20-gauge fragmatome is a viable option for removal of dense posteriorly dislocated crystalline lens material.
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