title: 25-Gauge Pars Plana Vitrectomy for Retained Lens Fragments in Complicated Cataract Surgery.
abstract: OBJECTIVE
  To verify the efficacy of 25-gauge pars plana vitrectomy (PPV) for the management of posteriorly dislocated lens material after complicated cataract extraction and to determine in what patients this approach offers the optimal benefit in terms of efficacy and safety, considering the amount of retained nuclear material and the duration of surgery.
  
  
  METHODS
  Forty eyes of 40 patients with retained lens fragments undergoing early (within 1 week) or late (within >1 week) 25-gauge PPV were retrospectively reviewed. The amount of dislocated nuclear material was graded by the surgeon intraoperatively, and the patients were divided into two groups according to the nuclear grading: group A (≤50% dropped nucleus) and group B (>50% dropped nucleus). The presence of brunescent nuclear pieces was considered. The outcomes measured included best-corrected visual acuity (BCVA) and postoperative complications such as retinal detachment, cystoid macular edema (CME) and postoperative ocular hypertension or hypotonia.
  
  
  RESULTS
  The patients had a mean age of 78 years. The mean preoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.57 ± 0.24 (20/80). A significant positive correlation was found between nuclear material grade and PPV duration (R2 = 0.81, p < 0.0001). None of the patients had dislocation of brunescent nuclear pieces. On postoperative day 1, the mean postoperative intraocular pressure was 16.75 ± 2.7 mm Hg, with no case of ocular hypotonia. At 6 months of follow-up, the mean logMAR BCVA improved to 0.23 ± 0.3 (20/32). Retinal detachment developed in 4 patients (10%), occurring only in patients of group B (p < 0.002). Four patients with late PPV developed postoperative CME, with no case of CME among patients with early vitrectomy (p = 0.014).
  
  
  CONCLUSIONS
  Removal of dislocated lens fragments after complicated cataract surgery can be effectively managed with 25-gauge PPV, although it appears to be most efficient for cases with a limited amount of dislocated lens material. In consideration of the higher rate of retinal detachment observed in cases of prolonged PPV time, the expected duration of surgery should be taken into account when choosing the best surgical approach. Visual outcomes are not affected by the timing of PPV, whereas early vitrectomy seems to prevent the onset of inflammatory macular edema.
authors.affiliation: Department of Ophthalmology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Scupola
authors.forename: Edoardo
authors.initials: E
authors.lastname: Abed
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Sammarco
authors.forename: Gabriela
authors.initials: G
authors.lastname: Grimaldi
authors.forename: Paola
authors.initials: P
authors.lastname: Sasso
authors.forename: Rosa
authors.initials: R
authors.lastname: Parrilla
authors.forename: Salvatore
authors.initials: S
authors.lastname: Traina
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Blasi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007906:Lens Subluxation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D018918:Phacoemulsification / Q000009:adverse effects*; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*