الفهرس 
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Abstract
Cataract surgery is the most common operation performed in the world and has one of the highest success rates. Retained lens fragment is one of the most feared complications during cataract surgery and usually results from posterior capsular rupture or zonular dehiscence. The incidence of DROPped nucleus by experienced surgeons is 0.2% while that in the hands of inexperienced surgeons is 4 %.18,24,82,201 Retained lens fragments lead to loss of useful vision due to significant intraocular inflammation resulting in elevated intraocular pressure, corneal oedema, cystoid macular oedema, vitreous haemorrhage, vitreous opacification, and retinal tears and detachment.2-10,26,69
Despite advances in small-incision cataract surgery, IOL dislocation remains an important intraoperative or postoperative complication.30-32 Inadequate posterior capsular support from capsular or zonular rupture is usually the basis of IOL dislocation. Retinal detachment is an important comorbidity associated with posteriorly dislocated IOLs.
Previous studies have not definitively established surgical indications and optimal timing for management of retained lens material or dislocated IOLs. The management approach depends on surgeon preferences and individual case specifics.2,10,14-17
Appropriate management of posteriorly dislocated fragments and IOLs can restore useful vision. The use of phacoemulsification mandates availability of referral facilities for management of complications.10
The aim of this study was to report the clinical presentation of posteriorly dislocated lens fragments and IOL, to determine visual outcome and complications after PPV for posteriorly dislocated lens fragments and IOL.
This study was carried out at the department of ophthalmology, Assiut university Hospital, Assiut between January 2009 and May 2012.
Thirteen eyes having retained intravitreal lens fragments after cataract surgery were included. Pre-vitrectomy, raised IOP was found in 8 eyes, corneal edema in 11 eyes, uveitis in 11 eyes, and visual acuity was ≤ 6/60 in all eyes. After PPV, BCVA was 6/12 or better in 6 eyes (46.15%) , 6/18-6/36 in 4 eyes (38.5%) and 6/60 or worse in 2 eyes (15.4%). The comparison of pre-vitrectomy and post-vitrectomy visual acuity at 6th month visit was statistically significant (p-value = 0.003). Cystoid macular edema was recorded in one eye and epiretinal membrane was found in one eye. At end of follow-up, no patient developed retinal detachment or glaucoma after vitrectomy.
Regarding dislocated IOL, 15 eyes were enrolled. Preoperatively, IOP was normal in all eyes, no corneal edema, BCVA was 6/18 in 4 eyes, 9/24 and 6/36 in 7 eyes and 6/60 or worse in 4 eyes and macular edema in 10 eyes. At 6th month post-vitrectomy, BCVA was ≥ 6/12 in 9 eyes (60%), 6/18 to 6/36 in 4 eyes (26.7%), and 6/60 or worse in 2 eyes (13.3%). The comparison of pre-vitrectomy and post-vitrectomy visual acuity at last follow-up visit was statistically significant (p value = 0.004). Complications after PPV included glaucoma in 2 eyes and ERM in 1 eye. Cystoid macular edema persisted in 1 eye. At end of follow-up, no patient developed retinal detachment after vitrectomy.
This study concluded that patients having retained intravitreal lens fragments or posteriorly dislocated IOL can be managed safely with combined PPV and secondary IOL implantation that reduced the risk of postoperative complications and helped in restoration of useful vision.
In addition, our study showed results comparable to those of earlier studies but optimal timing of vitrectomy–lensectomy could not be determined from these data.
Recommendations:
1. Optimal Learning and training in phacoemulsification is critical.
2. Retina subspecialty unit and referral giudelines must be established to minimize sequelae of posterior segment complication following cataract surgery.
3. Prospective comparative blinded studies are needed to clear the debate of vitrectomy timing.