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H.-J. Park, A. R. Gohari, M. Shah, M. F. Smith, J. W. Doyle, R. Ratnakaram; Visual Outcome and Morbidity Associated With Dropped Nucleus Following Phacoemulsification Performed by Resident Physicians. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5467.
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Intravitreal dislocation of the crystalline lens is a rare but feared complication of phacoemulsification. Assessing the visual outcome and morbidity associated with this complication will help in improving clinical decision-making and patient care.
We performed a retrospective review of dropped nucleus following phacoemulsification performed by resident physicians from January 2003 to June 2006 at the University of Florida. We measured the best corrected visual acuity before surgery and after surgery at months 1, 3, 6, 9 and 12. We also assessed morbidities associated with this complication by measuring the number of eye drops instilled per day, number of follow-up visits, and additional surgeries.
Twenty-three cases of dropped nucleus were identified from January 2003 to June 2006. Of these cases ten cases (43%) showed improvement of vision, five (22%) showed no change, and eight (35%) showed worsening of vision. There was an average improvement of 0.78 (SD=3.49) lines on Snellen visual acuity chart. Excluding cases that had poor visual prognosis from CRAO, CSME, or macular scar, vision improvement was 0.83 lines on average. Within the first month after surgery patients had 6.3 average visits (SD=2.0), and within three months, 9.7 visits (SD=2.81) . Mean number of drops instilled per day was 20 with 80% of patients requiring oral steroids and/or diamox. At one month patients required an average of 11.6 drops instilled per day (SD=6.6), and at 3 months, 7 drops were instilled per day (SD=7.1). All cases required pars plana vitrectomy and lensectomy.
Majority of cases complicated by dropped nucleus resulted in no change or improvement in the final visual acuity. However, there was a significant medical burden to the patients. Furthermore, all cases with final visual acuity less than 20/400 were complicated by retinal detachment.
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