Purchase this article with an account.
S. Kiss, D. Vavvas; Removal of Retained Lens Fragments Using 25-Gauge Sutureless Vitrectomy Produces Excellent Anatomic and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5974. doi: https://doi.org/.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
With significant advancement in techniques and surgical instrumentation, a trend of more frequent use and expanding indications for 25-gauge pars plana vitrectomy has developed. Compared to the traditional 20-gauge techniques, 25-gauge vitrectomy permits the use of smaller, self-sealing wounds that may allow patients to recover quicker and may avoid the discomfort associated with conjunctival and scleral sutures. Here we present the outcomes of five cases of retained lens fragments following complicated cataract surgery that were removed using 25-gauge vitrectomy techniques.
Interventional case series.
Five cases of retained lens fragments were referred for vitrectomy following complicated cataract surgery. The indications for vitrectomy in all cases were uncontrolled intraocular inflammation and/or increased intraocular pressure (IOP). Four of the five cases had intraocular lenses placed at the time of cataract surgery; 1 patient was left aphakic. ETDRS visual acuity (VA) at presentation ranged from 20/100 to counting fingers; IOP ranged from 10 to 32 mmHg. In all five cases, 25-gauge vitrectomy was used to remove the lens fragments. In 2 cases, there was nuclear lens material that was too dense for complete removal by the 25-gauge vitrector. In these two cases, a limited conjunctival cut-down was performed, one sclerotomy site opened, a fragmatome introduced, and the nuclear material removed. VA at last follow-up ranged from 20/120 to 20/25, IOP from 8 to 18 mmHg. At last follow-up, intraocular inflammation and IOP were well controlled in all cases. No residual lens material was noted in any of the operated eyes. Interestingly, on post-operative day 1, all five patients reported less ocular discomfort following the 25-gauge vitrectomy/lensectomy when compared to the initial cataract surgery.
25-gauge pars plana vitrectomy and lensectomy is a practical and reasonable option in selected cases of retained lens fragments following complicated cataract surgery. In cases where dense nuclear lens material is present, the fragmatome may be introduced through an expanded sclerotomy site. Improved visual and anatomic outcomes combined with less patient discomfort may expand the indications for 25-gauge vitrectomy to include retained lens fragment removal.
This PDF is available to Subscribers Only