title: SUTURELESS CLEAR CORNEAL ULTRASONIC FRAGMENTATION FOR RETAINED LENS FRAGMENTS: A Pilot Study.
abstract: OBJECTIVE
  To describe the safety and efficacy of removing posteriorly dislocated lens fragments with the use of intravitreal ultrasonic fragmentation through a limbal, clear cornea self-sealing incision.
  
  
  METHODS
  Patients presenting with posteriorly luxated nuclei were enrolled in this prospective case series. Preoperative examination included evaluation of the corneal endothelium by means of specular microscopy. A 3-port 25+ pars plana vitrectomy was initially performed. Following vitrectomy, sclerotomies were sealed using scleral plugs and a limbal/clear corneal incision was performed for the insertion of the fragmatome probe. The incision was slightly larger (1 mm) than the diameter of the fragmatome probe (20 gauge = 0.81 mm) to avoid wound overheating. At the end of the procedure, an appropriate intraocular lens either sulcus-fixated or angle-supported was implanted. Primary outcome measures were mean postoperative best-corrected visual acuity, intraoperative or postoperative complications, and intraoperative challenging features.
  
  
  RESULTS
  In all eyes, fragmentation was completed successfully with a mean total ultrasound time of 113.4 seconds. Nucleus density was ≥3 in all cases (mean ± SD = 3.8 ± 0.4). Intraoperative challenges included viewing difficulties because of corneal distortion, fragment turbulence, and leakage through the limbal incision potentially compromising fundus visualization. There was statistically nonsignificant reduction in endothelial cell density ranging between 1932 ± 187 cells per square millimeter preoperatively to 1789 ± 213 cells per square millimeter at the first month postoperatively (P = 0.79).
  
  
  CONCLUSIONS
  Clear corneal, sutureless ultrasonic fragmentation seems to be a novel, safe, and efficient method for the removal of hard posteriorly dislocated lens fragments, sparing the need for a 20-gauge scleral port.
authors.affiliation: *Second Department of Ophthalmology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece; and †Department of Ophthalmology, University of Thessaly, Larissa, Greece.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Tzamalis
authors.forename: Chrysanthos
authors.initials: C
authors.lastname: Symeonidis
authors.forename: Irini P
authors.initials: IP
authors.lastname: Brazitikou
authors.forename: Dimitra
authors.initials: D
authors.lastname: Tzetzi
authors.forename: Nikos
authors.initials: N
authors.lastname: Chalvatzis
authors.forename: Sofia
authors.initials: S
authors.lastname: Androudi
authors.forename: Periklis
authors.initials: P
authors.lastname: Brazitikos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003315:Cornea / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D007906:Lens Subluxation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology; D012599:Sclerostomy; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*