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Br J Ophthalmol 1999;83:1135-1138 doi:10.1136/bjo.83.10.1135
  • Original Article
    • Clinical science

Retained intravitreal lens fragments after phacoemulsification: a clinicopathological correlation

  1. L M W Yeob,
  2. D G Charterisa,
  3. C Buncea,
  4. P J Luthertc,
  5. Z J Gregora
  1. aMoorfields Eye Hospital, City Road, London EC1V 2PD, bAsiaMedic Eye Centre, 350 Orchard Road, No 08–00 Shaw House, Singapore 238868, cInstitute of Ophthalmology, Department of Pathology, University College London, 11–43 Bath Street, London EC1V 9EL
  1. Mr David Charteris.
  • Accepted 25 June 1999

Abstract

AIMS To explore the relation between clinical course and timing of vitrectomy with the nature and intensity of intraocular inflammatory response in eyes with retained intravitreal lens fragments following complicated phacoemulsification.

METHODS Prospective evaluation of 22 eyes with retained lens fragments with emphasis on corneal clarity, uveitis, intraocular pressure (IOP), timing of vitrectomy, and visual outcome. Numbers of different types of inflammatory cells in vitreous washings were counted, masked to clinical details, in three non-overlapping adjacent high power fields. Relations between clinical and pathological findings were assessed.

RESULTS The IOP was raised in 19 eyes before vitrectomy and remained high in nine postoperatively. The latter had higher median total cell count (104 cells/mm2) than those with normal postoperative IOP (37 cells/mm2) but this difference was not statistically significantly different (p=0.17). Nine of 22 eyes underwent vitrectomy within 1 week of cataract surgery. Median total cell count in these eyes was 20 cells/mm2 compared with 140 cells/mm2 in eyes vitrectomised later—this difference was statistically significant (p <0.001). Final visual acuity was 6/12 or better in 13 eyes, these had fewer intravitreal inflammatory cells than the remaining six with poor visual outcome and no pre-existing cause for this (three patients excluded) (p=0.02). Macrophages were the predominant inflammatory cell type.

CONCLUSION There was significantly less inflammatory cell activity in eyes which had retained lens fragments removed early (within 1 week). Later removal was associated with persistently elevated IOP and poorer visual outcome.

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