OPERATION REPORTS ON DISLOCATED LENS FRAGMENTS
K.-H. Velhagen, F. Schweig
Introduction: Even though operation procedures have improved, dislocation of lenses or their fragments during cataract operations is still a serious complication. Considering our experience in pars plana vitrectomy with phacofragmentation after complicated cataract operations we will try to give advise on how to avoid serious events.
Material and method: Between 1991 and 1998 we operated on 55 patients who had suffered from dislocation of lens fragments into the vitreous body after having undergone preliminary operation in 10 different clinics or day hospitals.
Results: The fragments could be removed in all cases. Four eyes were accompanied by major choroidal haemorrhages, one of them went bliad since the extreme bleeding provoked by the preceeding operation could not be drained. 10 patients showed retinal ruptures and in some cases extensive detachment with inversion of the retina; lens fragments were located subretinally. We managed to reattach the retina in 8 cases, whereas one eye lost sight to secondary glaucoma during oil filling and one patient could not be operated on due to poor general condition. Except for one case case of chronic glaucoma preoperative tension increase could be regulated. Depending on the macular conditioa we were able to improve eye function in 49 patients.
Discussion: Favorable development (including IOL implantation) was achieved if the preliminary operation had been stopped early enough once complications had arisen. Repeatedly patients had not been sufficiently iaformed prior to treatment. 4 patients sought our help several months after the intervention and showed secondary glaucoma or retinal detachment. Extended and sometimes multiple retinal ruptures had been caused by the attempt to finish the operation successfully by means of anterior vitrectomy in spite of difficulties during lens removal.
Conclusion: Dislocation of lens fragments should be treated with pars plana vitrectomy or phacofragmentation soon. Terminating lens operations early at the onset of complications gives the possibility of successful correction, including immediate or later IOL implantation, however, attempting to remove the lens fragmeats dislocated into the vitreous body via the cataract operation access or leaving them in place can cause severe complications.
Augenklinik, Universitätsklinikum Charité, Campus Virchow-Klinikum, D- 13353 Berlin