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

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. (Am J Ophthalmol 2011;152:624-627. (C) 2011 by Elsevier Inc. All rights reserved.)