[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.197.65.227. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Citations 0
Clinicopathologic Reports, Case Reports, and Small Case Series
September 2002

Delayed Luxation of a Lens Nucleus After Vitrectomy

Arch Ophthalmol. 2002;120(9):1212-1213. doi:

Accidental lens damage occurs less than 1% of the time during vitrectomy for diabetic retinopathy and may necessitate concurrent lensectomy.1,2 We report an unusual late complication of pars plana vitrectomy—delayed luxation of the lens nucleus.

Report of a Case

A 52-year-old man with a 20-year history of diabetes mellitus sought treatment at the Parkland Memorial Hospital Ophthalmology Clinic, Dallas, Tex, because of redness and photophobia in the left eye for 3 days. One year previously, he underwent vitrectomy in the left eye for proliferative diabetic retinopathy complicated by nonclearing vitreous hemorrhage and neovascular glaucoma. Four months prior to the current development, he underwent a second vitrectomy in the same eye for recurrent vitreous hemorrhage. The surgeon noted no intraoperative complications, including lens touch with the instruments. On the first day after the second vitrectomy, best-corrected visual acuity was 20/400 OS, and a new posterior subcapsular cataract was noted.

On examination of the left eye, best-corrected visual acuity was hand motion at 1 ft. Circumcorneal hyperemia and keratic precipitates were noted on slitlamp biomicroscopy. The anterior chamber was deep, with a moderate inflammatory reaction and visible lens particles. Neovascularization of the iris was present at the pupillary margin but not in the angle of the anterior chamber on gonioscopy. The anterior lens capsule was displaced posteriorly and was wrinkled with an opacified anterior cortex, obstructing the view of the fundus (Figure 1). The lens nucleus and posterior lens capsule were not seen. Intraocular pressure was 12 mm Hg. B-scan ultrasonography revealed that the lens nucleus was resting on the retina (Figure 2).

Figure 1.
A slitlamp photograph of the left
eye shows a wrinkled anterior lens capsule with an opacified white anterior
lens cortex.

A slitlamp photograph of the left eye shows a wrinkled anterior lens capsule with an opacified white anterior lens cortex.

Figure 2.
A B-scan ultrasonogram of the
left eye shows a lens nucleus that is dislocated into the posterior segment.

A B-scan ultrasonogram of the left eye shows a lens nucleus that is dislocated into the posterior segment.

The patient was treated with a topical corticosteroid and cycloplegia for phacoantigenic uveitis and underwent pars plana lensectomy 5 days later. At the time of the operation, the anterior capsule and zonules were intact, but a large rent was found in the inferior posterior capsule.

Comment

After lens-sparing vitrectomy, the lens tends to fall slightly posteriorly, making accidental lens touch more likely during repeat vitrectomy.3 Our patient likely had an iatrogenic defect in the posterior capsule prior to luxation. The acute and persistent posterior subcapsular cataract seen after the second vitrectomy in our patient was likely due to direct trauma to the posterior lens. We theorize that increased intracapsular volume secondary to lens hydration caused extension of the posterior capsule defect and allowed the lens nucleus to fall into the posterior segment of the eye.

Luxation of the lens nucleus is an unusual late complication of vitrectomy. Cataract surgeons should be aware of the possibility of occult posterior capsule damage when performing cataract extraction after vitrectomy.

This study was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY.

The authors have no proprietary or financial interest in the material discussed in this article.

Corresponding author and reprints: Preston H. Blomquist, MD, Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9057 (e-mail: preston.blomquist@utsouthwestern.edu).

References
1.
Oyakawa  RTSchachat  APMichels  RGRice  TA Complications of vitreous surgery for diabetic retinopathy, I: intraoperative complications. Ophthalmology. 1983;90517- 521Article
2.
Novak  MARice  TAMichels  RGAuer  C The crystalline lens after vitrectomy for diabetic retinopathy. Ophthalmology. 1984;911480- 1484Article
3.
Faulborn  JConway  BPMachemer  R Surgical complications of pars plana vitreous surgery. Ophthalmology. 1978;85116- 125Article
×