Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes.

摘要

PURPOSE: To evaluate the ocular complications and visual outcomes in vitrectomized and nonvitrectomized eyes with retained lens fragments after phacoemulsification. SETTING: Department of Neurological, Psychiatric, and Ophthalmological Sciences, University of Padua, Padua, Italy. METHODS: This prospective nonrandomized study comprised 36 consecutive patients with retained intravitreal lens fragments after phacoemulsification. Eighteen eyes had a pars plana vitrectomy (Group 1), and 18 eyes (Group 2) were treated with medication only. Intraocular pressure (IOP), intraocular inflammation, cystoid macular edema (CME), and best corrected visual acuity (BCVA) were evaluated 1, 3, and 6 months postoperatively. RESULTS: Ophthalmoscopy and B-scan echography showed that the lens fragments were significantly larger in Group 1 than in Group 2 (P < .03). An uncontrollable IOP rise and inflammation prompted an early vitrectomy in 11 eyes in Group 1. At the 6-month follow-up, the IOP with medications was acceptable in 2 and 5 eyes in Group 1 and Group 2, respectively. Intraocular inflammation was no longer detectable 1 month after vitrectomy but persisted during the entire follow-up in Group 2. At 3 months, 5 eyes in Group 1 and 13 in Group 2 had CME and at 5 months, 3 eyes and 1 eye, respectively, had CME. The difference between groups was significant at both follow-ups (P < .05). Three retinal detachments, 1 before and 2 after vitrectomy, occurred in Group 1. The mean BCVA in Group 1 was better than in Group 2 during the entire follow-up; however, the difference was significant at 3 months only (P < .5). At 6 months, 94.4% in Group 1 and 83.2% in Group 2 had a BCVA of 20/50 or better and 66.6% and 55.5%, respectively, attained at least 20/30. CONCLUSIONS: Intraocular inflammation, increased IOP, and CME were major complications in nonvitrectomized eyes after phacoemulsification; retinal detachment occurred in 2 vitrectomized eyes. In eyes with intravitreal lens fragments after phacoemulsification, vitrectomy can yield faster visual rehabilitation and better quality of vision. Conservative management is feasible at the price of long-term intraocular inflammation and slower restoration of comparable visual function.