Visual outcomes in the management of dropped nucleus without using the fragmatome

Abstract

Background: Phacoemulsification (Phaco) and intraocular lens implantation is the commonest surgical practice for the treatment of cataract. Posterior capsular rupture and dropping the nucleus into the vitreous is one of the less common but sight threating complication of phacoemulsification. Trans pars plana posterior vitrectomy (TPPV), removal of the dropped lens fragments and insertion of an intraocular lens is the preferred treatment option for the above complication. The intraocular lens may be placed in the sulcus where capsular ring is intact or scleral fixation is done in the case of absent capsular ring. Methodology: This study is a retrospective review of patients who had TPPV, removal of the lens fragments through the corneal incision using torsional phaco hand piece and sulcus insertion of multipiece intraocular lens (IOL) as the treatment for dropped lens fragments complicating cataract surgery at Nawaloka Hospitals PLC, Colombo, Sri Lanka. Forty four consecutive patients who underwent TPPV from January 2018 to December 2019 have been studied. The notes on the medical records at the initial presentation, second and eighth week post vitrectomy records were reviewed. Results: Forty four patients were reviewed within the 24-month period. There were 30 (68.2%) males and 14 (31.8%) females. All the patients were operated within a week after phacoemulsification. The best corrected visual acuity was 6/9 or better in 33 (75%) eyes at two weeks and 8 weeks post-surgery. There were no major complications observed in the series. Conclusion: Dropped nucleus following phacoemulsification can be managed by removal of the lens through the corneal incision using phaco handpiece with good visual outcomes.