Removal of posterior segment retained lens material using the OZil phacoemulsification handpiece versus Fragmatome during pars plana vitrectomy.
OBJECTIVE
To assess the utility of the torsional phacoemulsification handpiece compared to the Fragmatome during pars plana vitrectomy for removal of posterior segment retained lens material.


METHODS
: Retrospective comparative case series.


METHODS
Thirty-four eyes of 34 patients at 2 centers who underwent pars plana vitrectomy for retained lens material with either torsional phacoemulsification or the Fragmatome were retrospectively reviewed. Lens material was graded by nuclear density and percentage of total nuclear size. The primary outcome measure was mean change in visual acuity. Secondary outcomes included intraoperative or postoperative complications, occurrence of mechanical malfunctions and metric data including the total ultrasound, phacoemulsification, and torsional times.


RESULTS
In the torsional ultrasound group (17 eyes), mean nuclear density was 3.6 and mean size was 63%. Mean initial logarithm of minimum angle of resolution visual acuity was 1.58 (20/760) and improved to 0.66 (20/80) at postoperative Month 3, a gain of 0.92 (P = 0.003). One eye developed a self-limited, peripheral, serous, choroidal detachment intraoperatively, whereas two eyes developed postoperative cystoid macular edema. Mean total ultrasound, phacoemulsification, and torsional times were 76.7, 13.4, and 63.3 seconds, respectively. Mean total operative time to remove retained lens material (excluding vitreous gel removal) was 111 seconds. All the patients demonstrated excellent followability based on independent observations by the surgeons. In the Fragmatome group (17 eyes), initial logarithm of minimum angle of resolution visual acuity was 1.51 (20/640) and improved to 0.6 (20/80) at postoperative Month 3, a gain of 0.91 (P < 0.001). One eye developed a retinal detachment at postoperative Week 2, whereas 3 eyes developed postoperative cystoid macular edema.


CONCLUSIONS
The use of torsional phacoemulsification during pars plana vitrectomy for retained lens material is a novel approach with potential advantages over the standard 20-gauge Fragmatome, including improved followability and purchase of lens material attributable to the addition of torsional movement.
Mid Atlantic Retina, Retina Service of Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Allen
A
Chiang
Sunir J
SJ
Garg
Rayan A
RA
Alshareef
John D
JD
Pitcher
Allen Y
AY
Hu
Marc J
MJ
Spirn
Jason
J
Hsu
R Gary
RG
Lane
Carl D
CD
Regillo
Allen C
AC
Ho
Steven D
SD
Schwartz
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007906:Lens Subluxation / Q000601:surgery*; D007908:Lens, Crystalline; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000295:instrumentation*; D057972:Posterior Eye Segment / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy