First Author: V.Zygoura UK
Co Author(s): E. Papavasileiou Y. Antoniou A. Malik C. McKechnie
Purpose:
A dropped nucleus is a relatively rare but significant and challenging complication of cataract surgery. The intraoperative management of vitreous loss and dropped nucleus strongly influence the outcome of cataract surgery. There are currently no official guidelines, or any agreed general consensus as to how to surgically optimally manage a dropped nucleus.
The purpose of our study is to conduct a survey to establish the current opinion among non-vitreoretinal ophthalmic surgeons in the surgical management of a dropped nucleus.
Setting:
: 1. Moorfields Eye Hospital, London
2. Whipps Cross University Hospital, London
Methods:
A European-wide survey of 123 non-VR trained ophthalmic surgeons was conducted from 1rst March to 31rst March 2012. A web-based tool was used to conduct a survey of current opinion for non-vitreoretinal trained surgeons. This included trainees and consultant level ophthalmic surgeons.
10 questions regarding the surgical management of a dropped nucleus were posed. Data was collected using this web-based programme. All responses were anonymised.
Results:
The survey results are summarised in the charts below.
Of those surveyed: 6% were ST1-3, 20.2% were ST4-7, 20.2% were Fellows and 53.6% were consultants.
31.7% of surgeons believe vitrectomy surgery should be performed within a week of nucleus drop, 30.9% on the same day, and 27.6% within two days, for the removal of retained lens matter. Only 19.6% of non-vitreoretinal surgeons do not perform anterior vitrectomy.
Only 21.9% of surgeons feel that if there is a dropped nucleus in the first eye, then the second eye ought to be performed by a vitreoretinal surgeon.
Conclusions:
With regards to the surgical management of a dropped nucleus, there is no agreed opinion among ophthalmic surgeons on:
- the use of triamcinolone to visualise the vitreous
- the insertion of an intraocular lens implant
- the use of a corneal suture if the wound is not leaking
Furthermore there is no consensus on the type of lens to use or the urgency with which vitrectomy should be performed.
However non-vitreoretinal surgeons broadly agree that anterior vitrectomy should be performed for dropped nucleus and a dropped nucleus does not necessitate operation on the second eye to be done by a VR surgeon.
These survey findings confirm that there is a need for standardized guidelines and training in order to ensure the safe and effective surgical management of a dropped nucleus.
Financial Disclosure:
None
