title: Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments.
abstract: OBJECTIVE
  To identify factors that determined the outcome of eyes that underwent pars plana vitrectomy for retained lens fragments after phacoemulsification.
  
  
  METHODS
  A retrospective review of the records of 63 eyes that underwent vitrectomy for retained lens fragments after phacoemulsification. Fragments were defined as nuclear if they contained any nucleus component or non-nuclear if they contained only cortex and epinucleus. Nuclear fragments were further divided into large (at least 1/3 the size of the nucleus) or small.
  
  
  RESULTS
  A total of 67% of eyes had retained nuclear fragments and 33% had non-nuclear fragments. Of the eyes with nuclear fragments, 64% had large fragments and 36% had small fragments. Statistical analysis revealed that the lens fragment type was the major determinant of the final visual acuity (VA). Only 38.8% (14/36) of the eyes with nuclear fragments achieved final VA of 20/40 or better, compared with 77.7% (14/18) of eyes with non-nuclear fragments (p=0.007). All other parameters, including size of the nuclear fragment, were not correlated with final VA. The major complications encountered in this series were retinal detachment (12.6%), pseudophakic bullous keratopathy (6.3%), cystoid macular edema (15.8%), and glaucoma (15.8%).
  
  
  CONCLUSIONS
  The major finding of our study is that posterior dislocation of nuclear lens fragments is associated with worse visual outcome than that of non-nuclear fragments. This may be related to a more complicated course of the cataract surgery, direct mechanical damage to the retina, a stronger inflammatory response, or a more traumatic vitrectomy procedure.
authors: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. elad_moi@netvision.net.il
authors: Elad
authors: E
authors: Moisseiev
authors: Michael
authors: M
authors: Kinori
authors: Yoseph
authors: Y
authors: Glovinsky
authors: Anat
authors: A
authors: Loewenstein
authors: Joseph
authors: J
authors: Moisseiev
authors: Adiel
authors: A
authors: Barak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007904:Lens Cortex, Crystalline / Q000473:pathology*; D007907:Lens Nucleus, Crystalline / Q000473:pathology*; D007906:Lens Subluxation / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy