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Ruiz-Moreno JM, Barile S, Montero JA. Phacoemulsification in the Vitreous Cavity for Retained Nuclear Lens Fragments. Eur J Ophthalmol 2018; 16:40-5. [PMID: 16496244 DOI: 10.1177/112067210601600108] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate anatomic and functional results after surgery of retained lens fragments in the vitreous cavity after previous phacoemulsification. Methods The authors studied retrospectively 18 patients who underwent pars plana vitrectomy (PPV) for retained nuclear lens fragments. Patients having only cortical material in the vitreous cavity were excluded. In all cases the nucleus or nuclear fragments were removed after a complete vitrectomy using perfluorocarbon injection in the vitreous cavity, associated with phacoemulsification in the vitreous cavity. The authors used a conventional phaco probe devoid of the silicone sleeve. Time lapse between cataract surgery and vitrectomy varied between 0 and 24 days (mean 8.2 ± 7.4). Follow-up was 33.9 ± 20.6 months (range 4 to 53). Results The mean final best-corrected visual acuity (BCVA) was 20/45 (range 20/400 to 20/20). It was 20/40 or better in 33% of patients, reaching 40% when patients with pevious macular disease were excluded. A total of 61% of patients reached a final BCVA ranging from 20/50 to 20/200. Retinal detachment occurred in one eye and topical medications were necessary to manage intraocular pressure in four cases. Conclusions PPV with intravitreous phacoemulsification is the technique of choice for dislocated nuclei or nuclear fragments in the vitreous cavity.
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Affiliation(s)
- J M Ruiz-Moreno
- Department of Ophthalmology, Miguel Hernandez University School of Medicine and Vitreo-Retinal Unit, Instituto Oftalmologico de Alicante, Alicante, Spain.
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Naik MP, Sethi H, Mehta A, Bhalla A, Saluja K. Spontaneous levitation of dropped nucleus on first post-operative day. SAGE Open Med Case Rep 2017; 5:2050313X17708713. [PMID: 28540056 PMCID: PMC5431602 DOI: 10.1177/2050313x17708713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/12/2017] [Indexed: 12/04/2022] Open
Abstract
A 60-year-old male patient presenting with gradual painless progressive diminution of vision was diagnosed with nuclear sclerosis grade III (LOCS). Intra-operatively, there was a nuclear drop into the vitreous cavity. The patient was left aphakic and was deferred for further vitreoretinal procedure the next day. On first post-op day, the nucleus fragment (of roughly the same size that had dropped into the vitreous) was seen in the anterior chamber. A gentle ultrasonography B-Scan done for posterior segment evaluation was anechoic. Incision was enlarged and viscoexpression of the nucleus fragment was done followed by thorough anterior vitrectomy. Post-operatively, dilated full fundus examination showed clear vitreous cavity without any evidence of retinal tear or detachment. This was later confirmed by an anechoic ultrasonography B-Scan. After 2 weeks, three-piece foldable IOL was placed in the sulcus with posterior optic capture and the patient attained a best-corrected visual acuity of 6/9P.
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Affiliation(s)
- Mayuresh P Naik
- Department of Ophthalmology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Harindersingh Sethi
- Department of Ophthalmology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Anuj Mehta
- Department of Ophthalmology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Abhinav Bhalla
- Department of Ophthalmology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Komal Saluja
- Department of Ophthalmology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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Pastor-Idoate S, Bonshek R, Irion L, Zambrano I, Carlin P, Mironov A, Bishop P, McLeod D, Stanga PE. Ultrastructural and histopathologic findings after pars plana vitrectomy with a new hypersonic vitrector system. Qualitative preliminary assessment. PLoS One 2017; 12:e0173883. [PMID: 28399127 PMCID: PMC5388328 DOI: 10.1371/journal.pone.0173883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/28/2017] [Indexed: 01/28/2023] Open
Abstract
Purpose Preliminary assessment of a new prototype ultrasound-based hypersonic vitrector (HV) by qualitatively examining the histopathological changes in the retina and vitreous body after pars plana vitrectomy (PPV) and its ability to fragment vitreous collagen. Methods Fourteen porcine cadaveric eyes, 20 eyes in live swine and six human cadaveric eyes underwent PPV using the HV or a pneumatic guillotine vitrector (GV). An additional 4 porcine crystalline lenses were touched with either the HV or GV for 1 minute. Following PPV, human vitreous was removed and processed for electron microscopy (EM). Eyes and lenses were fixed and sectioned for light microscopy (LM). Results There were no macroscopic retinal or optic nerve defects associated with either HV or GV PPVs. Cadaveric retinal specimens showed separation of the inner limiting membrane (ILM) and vacuolization and fragmentation at the nerve fiber layer (NFL) and the ganglion cell layer (GCL). ILM fragmentation and separation were found after PPV in live swine with both vitrectors. Small disruptions of the posterior capsule or structural lens defects were found after HV touch. The EM analysis revealed more fragmentation of human vitreous collagen fibrils after HV compared to GV PPV. Conclusions LM and EM analysis of retina, vitreous, and crystalline lens after PPV showed similar morphological changes using the HV or the GV. Vitreous fragmentation appeared more effective with the HV. Overall this study suggests that the HV may be a promising new technology. More work is needed to quantitatively assess its safety and efficacy.
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Affiliation(s)
- Salvador Pastor-Idoate
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital and NIHR/ Wellcome Trust Manchester CRF, Manchester, United Kingdom
| | - Richard Bonshek
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Specialist Ophthalmic Pathology Service, Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Luciane Irion
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Specialist Ophthalmic Pathology Service, Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Isaac Zambrano
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Eye Bank, Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Paul Carlin
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Operating Theatre Services, Manchester Royal Eye Hospital, Manchester, United Kingdom
| | - Aleksandr Mironov
- Electron Microscopy Core Facility, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Paul Bishop
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - David McLeod
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Paulo Eduardo Stanga
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital and NIHR/ Wellcome Trust Manchester CRF, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
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Abstract
PURPOSE To evaluate the outcome and surgery-associated risks in patients undergoing 23-gauge pars plana vitrectomy (PPV) for retained lens fragments. METHODS Retrospective analysis of 42 eyes of 42 consecutive patients at a tertiary teaching hospital in Sydney (Australia) during a period of 4 years. Evaluation of final visual acuity, complications, differences in patients receiving an intraocular lens at the primary cataract surgery, and differences in final visual acuity regarding the usage of a phacofragmatome and analysis of pars plana vitrectomy-related complications. RESULTS The majority (83.3%) achieved a visual acuity of 0.3 (logarithm of the minimum angle of resolution) or better, and 19 eyes (45.2%) achieved a final visual acuity of 0 (logarithm of the minimum angle of resolution). Overall, 95.2% of the eyes had a better postoperative visual acuity compared with the preoperative visual acuity. There were no differences in proportions regarding the final visual acuity in patients who had an intraocular lens at the time of the pars plana vitrectomy and those who had a secondary lens implant. A retinal detachment after the lens fragment removal was observed in 2 eyes. CONCLUSION Dropped lens fragments because of complicated cataract surgery can be managed well with 23-gauge pars plana vitrectomy: The majority of patients achieve a good visual acuity despite 2 surgeries at a rather low rate of retinal complications.
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Al-Amri AM. Visual outcome of pars plana vitrectomy for retained lens fragments after phacoemulsification. Middle East Afr J Ophthalmol 2008; 15:107-11. [PMID: 21369465 PMCID: PMC3040913 DOI: 10.4103/0974-9233.51984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the visual outcome of patients who underwent pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments after phacoemulsification. Methods: A retrospective chart review was conducted of all patients who had PPV for posteriorly dislocated lens fragments after phacoemulsification between January 2000 and September 2004 in the Vitreoretinal Service at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Demographics, preexisting eye diseases, details of the previous cataract surgery, findings at presentation, details of the vitreoretinal procedures, final visual acuity, and complications observed during the follow-up were evaluated. Results: Of the 60 patients identified, 37 patients (37 eyes) had a full set of data and were included in the study. In 21 eyes (56.8%), PPV was performed within 1 week of cataract extraction; in 15 eyes (40.5%), PPV was performed more than 1 week postcataract extraction. An initial visual acuity of 20/200 or worse was found in 34 eyes (91.9%). The final visual acuity was 20/40 or better in 10 eyes (27%), and 20/200 or worse in 13 eyes (35.1%). Retinal detachments were found in 3 eyes (8.1%): 1 before and 2 after vitrectomy. Conclusion: There was no statistically significant difference in outcome between those having vitrectomy the first week after cataract surgery and those having it later; however, there was a trend of better visual outcome in early vitrectomy patients (within 1 week).
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Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. J Cataract Refract Surg 2006; 32:1521-6. [PMID: 16931266 DOI: 10.1016/j.jcrs.2006.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 04/17/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe the incidence and clinical course in patients with cystoid macular edema (CME) following pars plana vitrectomy (PPV) for retained lens fragments. SETTING Retina group, private practice. METHODS This retrospective study reviewed the medical records of 91 patients who had PPV for retained lens fragments. The patients were followed for at least 6 months. Patients with concomitant eye diseases that adversely affected macular examination or macular function were excluded. RESULTS Four (8%) of 50 eyes with a sulcus-fixated posterior chamber intraocular lens (PC IOL) implanted at cataract extraction and 19 (46%) of 41 eyes with aphakia or an anterior chamber IOL developed CME (P</=.001, chi-square test). The CME developed a mean of 4 months after PPV. Treatment consisted of steroid eyedrops in all eyes; 17 eyes were also treated with a topical cyclooxygenase inhibitor, and 5 eyes received posterior sub-Tenon's steroid injections. The CME resolved a mean of 2 months after 1 treatment course in 12 eyes, which had a final visual acuity of 20/40 or better. The CME resolved, recurred, and then resolved in 6 eyes. In these eyes, the first incidence lasted a mean of 4 months. The second episode occurred a mean of 5 months after the initial episode resolved and took a mean of 3 months to resolve. Final visual acuity was 20/40 or better in 5 of these eyes. The CME persisted in 5 eyes that were followed for a mean of 30 months. None of these eyes had an acuity of 20/40 or better. CONCLUSIONS Sulcus placement of a PC IOL at cataract extraction was associated with a reduced risk for CME. The prognosis for eyes that develop CME after PPV for retained lens fragments is guarded. Long-term therapy should be considered because of the high rate of recurrence.
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Affiliation(s)
- Steven M Cohen
- Department of Ophthalmology, University of South Florida, Tampa, USA.
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Omulecki W, Wilczynski M, Gerkowicz M. Management of Bilateral Ectopia Lentis et Pupillae Syndrome. Ophthalmic Surg Lasers Imaging Retina 2006. [DOI: 10.3928/1542-8877-20060101-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Omulecki W, Stolarska K, Synder A. Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses. J Cataract Refract Surg 2005; 31:2147-52. [PMID: 16412930 DOI: 10.1016/j.jcrs.2005.04.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2005] [Indexed: 11/20/2022]
Abstract
PURPOSE To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results. SETTING Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. METHODS This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral-fixated posterior chamber IOLs in 20 eyes. The follow-up mean was 5.2 month (range 1 to 16 months). RESULTS No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 +/- 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 +/- 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral-fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication. CONCLUSION Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.
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Affiliation(s)
- Wojciech Omulecki
- Department of Ophthalmology, Medical University of Lodz, Lodz, Poland.
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