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LETTER TO EDITOR
Year : 2000  |  Volume : 48  |  Issue : 2  |  Page : 159-61

Incidence and management of posteriorly dislocated nuclear fragments following phacoemulsification


Correspondence Address:
S Gopal


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Source of Support: None, Conflict of Interest: None


PMID: 11116517

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Keywords: Comparative Study, Humans, Incidence, Lens Implantation, Intraocular, methods, Lens Nucleus, Crystalline, pathology, Lens Subluxation, diagnosis, etiology, Phacoemulsifica


How to cite this article:
Gopal S. Incidence and management of posteriorly dislocated nuclear fragments following phacoemulsification. Indian J Ophthalmol 2000;48:159

How to cite this URL:
Gopal S. Incidence and management of posteriorly dislocated nuclear fragments following phacoemulsification. Indian J Ophthalmol [serial online] 2000 [cited 2020 Feb 27];48:159. Available from: http://www.ijo.in/text.asp?2000/48/2/159/14882

The article "Management of posteriorly dislocated nuclear fragments" by Drs. Annie Mathai and Ravi Thomas (Indian J Ophthalmol 1999; 47:173-76) raises a number of important issues.

National data are not available to indicate the extent of this problem. I do believe that quite a few ophthalmologists in private practice and those in Government and institutional practice are into phacoemulsification.

Even if we assume that the total number of phacoemulsifications performed in India do not exceed 100,000 per year (could be a gross underestimation) and assuming a moderate 0.5% as the nucleus drop rate we are looking at 500 cases per year!

Where are these cases and how are they being managed? Who is looking after these cases and how many vitreoretinal surgeons are there in India with expertise to deal with these cases? What is the economic implications? These are some of the questions that need to be addressed at the national level. Perhaps a national registry by All India Ophthalmological Society for the Phaco surgeons and a national survey may help in comprehending the problem at the national level.

The authors appear to recommend that an intraocular lens (IOL), anterior or posterior chamber, can be placed in events of nucleus drop, before vitrectomy. I have managed a few of these dropped nuclei in the past while managing a vitreoretinal clinic. I find it very difficult to accept that the authors advocate inserting an IOL before managing the dropped nuclei. It is extremely difficult to remove a large and hard nucleus unless it is brought/floated up in to the anterior chamber and rephacoed. This is more likely to be so when the nucleus drops soon after hydrodissection and in cases with pseudo exfoliation. This manoeuvre would be extremely difficult in the presence of a posterior or anterior chamber IOL.

The article does not clearly mention how exactly the different dropped nuclei were tackled and the difficulty encountered. The presence of a few lens fibres or for that matter very small nuclear fragments will not necessarily evoke a very severe reaction in the eye.

I have had the misfortune of examining a patient with a dropped nucleus and a dislocated posterior chamber IOL and and anterior chamber IOL in place! I am sure there will be many more such cases if we adhere to the principle of positioning an IOL before vitrectomy.

Not all phaco surgeons are trained to do vitrectomy and therefore it is prudent to refer these cases of dropped nucleus to the nearest vitreoretinal surgeon before placing an IOL.






 

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