DROPPED NUCLEUS DURING PHACOEMULSIFICATION

Introduction: The increasing popularity of phacoemulsificalion in restoring good visual acuity has also led to an increase in the incidence of its complications like nucleus drop during the procedure. Proper management of such patients not only reduces intravitreal lens fragments related complications but also significantly improves the visual acuity. Objectives: To evaluate the clinical features of the eye with retained Intravitreal lens fragments after the phacoemulsification surgery. We also aimed to investigate the incidence of cystoid macular edema, retinal detachment, suprachoridal hemorrhage and any other complication in patients after pars plana vitrectomy for retained intravitreal lens fragments. Setting: This study was carried out at the department of ophthalmology, Lahore General Hospital, Lahore. Period: The duration of study was one year 17-05-2004 to 28-04-2005. Study Design: Descriptive prospective. Material & Methods: The reported frequency of dislocated lens material at 0.3% is quiet low. Despite LGH being a referral center for retinal diseases, dropped nuclei and nuclear fragments constitute a very small fraction of the referred cases. Therefore the study was limited to 15 cases only so that it could be completed within specified period. Results: 15 eyes having retained lens matter after phacoemulsification surgery were included. Aphakia was present in 10(66.75%) patients. 5 (33.4%) patients were pseudophakic. Raised intraocular pressure was found in 11 (73.4%) patients, cornea! edema in 7 (46.7%), uveitis in 6 (40%) patients. Two (13.4%) patients had retinal detachment at presentation. The range of visual acuity way perception and projection of light to counting fingers in 9 eyes (60%), 2/60-6/60 in 5 eyes (33.4%). 6/24 in 1 (6.64%) eye preoperatively. After vitrectomy, range of visual acuity was 6/9 to 6/18 in 9 patients (60%) and 6/24-6/60 in 6 patients (40%). The comparison of pre-operative visual acuity and that of last follow-up showed p<0.01 (statistically highly significant). Intraocular pressure was raised in only 2 patients (13.3%). No patient developed retinal detachment. Cystoid macular edema was found in only 2 patients (13.4%).No patient developed significant intraocular inflammation after vitrectomy. Conclusions: Patients having retained intravitreal lens fragments presented with raised intraocular pressure, reduced visual acuity, uveitis and retinal detachment. In such patients combined pars plana vitrectomy and secondary intraocular lens implantation reduced the risk of postoperative complications including secondary glaucoma, uveilis and helped in restoration of useful visual acuity.