Posters

Risk factors, post-operative course and final visual outcome in complicated cataract cases with dropped nuclear fragment and secondary pars plana fragmatome lensectomy

Poster Details

First Author: G.Siasou GREECE

Co Author(s):    M. Dari   V. Kit   S. Khan              

Abstract Details

Purpose:

The purpose of this retrospective study was to compare our results with the Royal College of Ophthalmologist’s National Ophthalmology Database Study of cataract surgery (NOD 2015) and to evaluate the risk factors, the post-operative course and the final visual outcome (best corrected visual acuity-BCVA) in complicated cataract cases with dropped nucleus or nuclear fragment.

Setting:

Moorfields Eye Hospital, UK.

Methods:

Retrospective review of the records of all the patients who were planned to have cataract extraction and posterior chamber lens implantation only, but ended up having pars plana vitrectomy (PPV) and fragmatome lensectomy due to an intraoperative complication resulting in dropped nuclear fragment over a 12-month period.

Results:

Out of a total number of 18643 cataract surgeries that were performed trustwide over a 12-month period, there were 211 cases of posterior capsule rupture (1.13%) and 33 cases of dropped nucleus (0.18%), which is lower than NOD standards 1.95% and 0.2% respectively. Several risk factors were identified in the study group including white or brunescent cataract (33% of the complicated cases), phacodonesis (12%), previous vitrectomy (18%), previous trauma (6%), pseudoexfoliation (12%) and previous intravitreal injections (6%). Following PPV 27% developed persistent uveitis, 15% cystoid macular oedema, 17% retinal detachment (RD)/tear, 7% corneal decompensation and 0% endophthalmitis.

Conclusions:

The final BCVA was6/9 or better in 49% of the cases. From the remaining 51% with final BCVA 6/12 or worse 34% had pre-existing eye conditions that were expected to compromise the visual outcome like geographic atrophy, macular hole, previous macula-offRD and proliferative diabetic retinopathy, and in the other 17% the vision ranged between 6/18 and6/12 despite all interventions. Overall, complications like a dropped nucleus may happen during cataract surgery especially in high risk cases, but with appropriate post-operative management and in the absence of other ocular pathology the final visual outcome is very satisfactory in the majority of cases.

Financial Disclosure:

None