Original article
23-Gauge Transconjunctival Pars Plana Vitrectomy for Removal of Retained Lens Fragments

https://doi.org/10.1016/j.ajo.2011.04.003Get rights and content

Purpose

To examine the usefulness of 23-gauge pars plana vitrectomy (PPV) in removing retained lens fragments and to determine which cases require 20-gauge ultrasonic fragmentation.

Design

Retrospective comparative case series.

Methods

Twenty eyes in 20 consecutive patients who had 23-gauge PPV for retained lens fragments after complicated cataract surgery at Wills Eye Institute were retrospectively reviewed. Retained lens fragments were graded based on percentage of total nuclear size. Every surgical case started with 23-gauge PPV, but 1 sclerotomy was enlarged to facilitate 20-gauge ultrasonic fragmentation if all lens material could not be adequately removed.

Results

Twelve patients (60%) were successfully managed with 23-gauge PPV alone while 8 patients (40%) required 20-gauge ultrasonic fragmentation. The 23-gauge cases had a lower percentage of retained lens fragments (median 10%, range 0% to 75%) compared to the 20-gauge cases (median 90%, range 10% to 100%).

Conclusion

23-Gauge PPV is a feasible approach in the surgical management of select cases of retained lens fragments.

Section snippets

Methods

The medical records of consecutive patients at the Wills Eye Institute Retina Service from March 11, 2008 to June 17, 2008 who underwent PPV for retained lens fragments after complicated cataract surgery were retrospectively reviewed. Patients were referred at different times after cataract surgery and underwent PPV at the discretion of the retinal surgeon. Preoperative, intraoperative, and postoperative patient data were collected from the medical records, including patient demographics,

Results

Twenty eyes of 20 patients underwent PPV for retained lens material following complicated cataract surgery (see Table). The initial surgery in every case was small-incision phacoemulsification for a visually significant cataract. The mean follow-up duration was 16 weeks (range 5 to 32 weeks). An intraocular lens was placed at the time of the initial surgery in 17 eyes. Three eyes were left aphakic after their initial surgery and a secondary intraocular lens was placed during their second

Discussion

Recent advances in vitreoretinal surgery have enabled surgeons to perform small-incision, sutureless PPV and have provided different options for handling retained lens material after complicated cataract extraction. Machemer revolutionized the field of vitreoretinal surgery when he introduced PPV in 1972 using a single-port, 17-gauge vitrector system.6 In 1975 O'Malley and Heintz reported the use of 20-gauge instrumentation for PPV, which became the standard of care for many years.7 Over the

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