Removal of Dislocated Lens Fragments During Cataract Surgery

Removal of Dislocated Lens Fragments During Cataract Surgery

Abstract and Introduction

Abstract

Aim To describe a new method of removing dislocated nuclear fragments smaller than one-fourth the size of the lens nucleus through the sclerocorneal incision made for cataract surgery.
Methods Dislocated lens nuclear fragments on the surface of the retina were removed from six eyes of six consecutive patients. An anterior vitreous cutter with a 27-gauge chandelier endoilluminator (Twinlight illumination) tied to its sleeve was inserted into the eye through the incision made for cataract surgery and used for core vitrectomy. A fragmatome with another 27-gauge chandelier endoilluminator (Twinlight illumination) fibre was used to grasp and move the larger dislocated nuclear fragments into the anterior chamber where they were divided and removed.
Results All dislocated nuclear fragments were removed through the incision for cataract surgery, and a posterior chamber lens was implanted in each patient without major complications.
Conclusions The procedure can be used to remove dislocated lens nuclear fragments from the surface of the retina through the incision for cataract surgery. Neither a second surgery, which would require three ports, nor the body of instruments for vitreal surgery are needed with this procedure.

Introduction

Dislocation of fragments of the nucleus of the lens into the vitreous cavity is a complication of cataract surgery with phacoemulsification. These nuclear fragments can lead to intraocular inflammation, cystoid macular oedema, epiretinal membrane (ERM) formation and increased intraocular pressure. Their removal is generally difficult for cataract surgeons. Conventionally, a second surgery is performed, and the dislocated nuclear pieces are emulsified with a fragmatome and aspirated during pars plana vitrectomy (PPV). More recently, Ryan reported removing nuclear fragments with the shielded bullet pick and fragmatome during PPV. Both methods require a second surgery, and specialised vitreal instruments, such as the body of instruments for vitreal surgery, are needed.

We describe a new method of removing dislocated nuclear fragments that are smaller than one-fourth the size of the lens nucleus through the sclerocorneal incision made for cataract surgery during cataract surgery.