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Purpose: The objective is to reveal the results of patients who underwent pars plana vitrectomy (PPV) in the same session due to lens nucleus drop during cataract extraction and to compare the refractive results according to uncomplicated pha)coemulsification (phaco) surgery. Methods: The study included 26 eyes of 26 patients who underwent PPV due to lens or lens fragments drop. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent, and the intraocular lens (IOL) implantation methods applied were recorded. Refractive results were compared with the spherical equivalent of 24 eyes of 19 patients who underwent uncomplicated phaco surgery. Results: Three-piece IOL was implanted in the ciliary sulcus in 20 (77%) patients, and IOL was implanted in one (4%) patient with sutureless scleral fixation using the Yamane technique. In 5 (19%) cases, the surgeries were terminated as aphakic. Preoperative BCVA was 1.3±0.5 logMAR, and postoperative BCVA was 0.29±0.4 logMAR (P<0.001 for both subgroups). Preop)erative spherical equivalent was −4±2 D, and it was −0.8±1.4 D after the operation (P<0.001). In patients with PPV and IOL implantation, the postoperative spherical equivalent was −0.8±1.4 D, and it was measured as −0.7±0.6 D in the phaco-only group (P=0.37). Conclusion: It is possible to achieve optimal results in uncomplicated phaco surgery using IOL measurements calculated with appropriate biometric formulas and advanced optical biometry devices in patients who have undergone PPV due to lens nucleus drop. IOL implantation can be easily planned in the same session for patients undergoing PPV [ABSTRACT FROM AUTHOR]

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Objective: Phacoemulsification is the predominant method for cataract surgery, but complications like lens nuclei dislodgment into the vitreous cavity pose significant risks, including inflammation, glaucoma, retinal tears, and vision loss. Traditional management involves pars plana vitrectomy with phacofragmentation, which can increase the risk of retinal damage due to repulsive forces. This study tests whether the OZil phacoemulsification handpiece, employing torsional movement, offers a safer alternative by minimizing repulsive forces and reducing surgical duration compared to the traditional phacofragmatome., Methods: This prospective study, conducted in a tertiary care hospital in eastern India from January to June 2023, enrolled 40 patients with nucleus dislocation during cataract surgery. Patients were randomized into Group 1 (traditional phacofragmatome) and Group 2 (OZil handpiece). Primary objectives included comparing the duration of surgery and intraoperative complications. Secondary objectives assessed postoperative best-corrected visual acuity (BCVA), surgical site safety, and cystoid macular edema (CME) incidence., Results: Group 2 demonstrated significantly shorter surgical durations (110±2.54 seconds) compared to Group 1 (152±2.23 seconds, p < 0.001). The frequency of nucleus falls was considerably lower in Group 2 (p < 0.001). Postoperative BCVA and CME incidence showed no significant differences between groups. Multiple regression analysis confirmed the OZil handpiece significantly reduced surgical duration (β = -0.40, p < 0.001) without compromising safety., Discussion: The OZil handpiece's rotational cutting mechanism offers a significant advantage in reducing surgical time while improving the followability of lens fragments, as compared to the traditional phacofragmatome. It addresses one of the key limitations of phacofragmentation by minimizing fragment displacement, where repulsive forces can complicate the procedure. Although both techniques showed similar safety profiles, the OZil handpiece's operational efficiency makes it a promising alternative for managing posteriorly displaced lens fragments in complex cases., Conclusions: The OZil phacoemulsification handpiece significantly enhances surgical efficiency and safety in nucleus drop surgeries. Its integration into existing phacofragmatome systems can lead to major advancement in the ophthalmic surgical armamentarium, ensuring improved patient care., Competing Interests: The authors state no conflict of interest regarding the research, authorship, and/or publication of this article., (© 2024 The Authors.)

Small incision cataract surgery (SICS) offers the benefits of a phacoemulsification (phaco) surgery without the attendant high cost, but it is not without certain risk such as nucleus drop into the vitreous as seen in phaco. A retrospective study of SICS and associated factors leading to nucleus drop during surgery, challenges of management and the visual outcomes. Of 793 eye surgeries performed during the study 586 were SICSs. Nucleus drop during SICS occurred in 0.68% of patients. Can-opener technique of capsulotomy, use of dispersive viscoelastic, diabetes mellitus, lack of anterior vitrectomy machine and poor access to immediate posterior vitrectomy were important problems in the management of the cases of nucleus drop in this study. The visual outcomes were poor in all the cases of nucleus drop. Careful patient selection for SICS and the use of continuous curvilinear capsulorhexis are advocated. An interior vitrectomy machine should be available to all cataract surgeons. It is good professional practice to be acquainted with the available vitreo-retina surgeons for urgent assistance in cases of nucleus drop.

Purpose: To compare the outcomes of iris claw anterior chamber intraocular lens (ICACIOL) with that of scleral fixation posterior chamber intraocular lens (SF-PCIOL) implantation during pars plana vitrectomy (PPV) as initial surgery to correct aphakia. Methods: Twelve patients with complicated cataract surgery or trauma who had suffered nucleus, whole crystalline lens or intraocular lens (IOL) drop into the vitreous cavity, and undergone PPV with IC-ACIOL implantation over a period of one year were evaluated for the purpose of this study. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central corneal thickness (CCT), spherical equivalent (SE) refractive error, astigmatism and complications were recorded. The results were compared to outcomes of another group of 13 patients who had previously undergone PPV with SF-PCIOL implantation. Results: Mean improvement of UCVA was greater in IC-ACIOL eyes as compared to the SF-PCIOL group (-1.17±0.28 versus -0.89±0.21 logMAR, P=0.01), corresponding values for postoperative BCVA were 0.24±0.17 and 0.44±0.22 logMAR (P=0.041), respectively. Average postoperative SE was comparable in the IC-ACIOL and SFPCIOL groups at 0.6±1.03 and 0.56±1.23 diopters, respectively (P=0.290). However, 10 (83.3%) IC-ACIOL eyes versus 6 (46.1%) SF-PCIOL eyes had SE within 1 diopter of emmetropia (P=0.048). Mean postoperative increase in CCT was comaparble between the study groups (P=0.126). Conclusion: In the absence of sufficient capsular support, the use of an IC-ACIOL for correction of aphakia during PPV can be a good alternative and seems to entail better visual outcomes as compared to SF-PCIOL.

Introduction: On the basis of development in vitrectomy procedure a whole new subspecialty termed vitreoretinal surgery has evolved over past 30 years. We conducted this study to evaluate usefulness and necessity of Pars plana vitrectomy in today’s time. Methods: A hospital-based cross-sectional study of series of cases was carried out in retina clinic of SMIMER, Surat, Gujarat, From July 2012 to November 2014. 46 patients who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications and preoperative visual acuity analyzed. Results: Of 46 patients, preoperatively, 89 % had visual acuity of 2/60 to perception of light .The main indication for TPPV was nuclear drop, in 50 %. Other indication in our study are vitreous haemorrhage (26.1%), proliferative retinopathy (15.2%), trauma (15.2%), dislocated IOL (6.5%), endopthalmitis (6.5%) and retinal detachment (2.2%). Conclusion: VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. The main indication for TPPV is Nucleus drop as our centre is a tertiary care referral centre. Main aetiology of vitreous haemorrhage was diabetic retinopathy.

Purpose: To compare the outcomes of iris claw anterior chamber intraocular lens (ICACIOL) with that of scleral fixation posterior chamber intraocular lens (SF-PCIOL) implantation during pars plana vitrectomy (PPV) as initial surgery to correct aphakia. Methods: Twelve patients with complicated cataract surgery or trauma who had suffered nucleus, whole crystalline lens or intraocular lens (IOL) drop into the vitreous cavity, and undergone PPV with IC-ACIOL implantation over a period of one year were evaluated for the purpose of this study. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central corneal thickness (CCT), spherical equivalent (SE) refractive error, astigmatism and complications were recorded. The results were compared to outcomes of another group of 13 patients who had previously undergone PPV with SF-PCIOL implantation. Results: Mean improvement of UCVA was greater in IC-ACIOL eyes as compared to the SF-PCIOL group (-1.17±0.28 versus -0.89±0.21 logMAR, P=0.01), corresponding values for postoperative BCVA were 0.24±0.17 and 0.44±0.22 logMAR (P=0.041), respectively. Average postoperative SE was comparable in the IC-ACIOL and SFPCIOL groups at 0.6±1.03 and 0.56±1.23 diopters, respectively (P=0.290). However, 10 (83.3%) IC-ACIOL eyes versus 6 (46.1%) SF-PCIOL eyes had SE within 1 diopter of emmetropia (P=0.048). Mean postoperative increase in CCT was comaparble between the study groups (P=0.126). Conclusion: In the absence of sufficient capsular support, the use of an IC-ACIOL for correction of aphakia during PPV can be a good alternative and seems to entail better visual outcomes as compared to SF-PCIOL. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate risk factors, clinical features, the anatomic and visual outcomes of patients with retained lens fragments removed by pars plana vitrectomy (PPV). Materials and Methods: Fifty five consecutive eyes of 55 patients with retained lens fragments who underwent PPV between June 2001-December 2004 were reviewed retrospectively. Results: Five patients had PPV on the same day as the cataract extraction and did not have initial outpatient examination records. Of the 50 patients, 42 (84%) had an initial visual acuity of 20/400 or worse. Ocular findings on presentation included significant intraocular inflammation in 18 eyes (36%), increased intraocular pressure in 15 eyes (30%), corneal oedema in 21 eyes (42%), retinal detachment in 6 eyes (12%), vitreous haemorrhage in 3 eyes (6%), and choroidal detachment in 3 eyes (6%). Rhegmatogenous retinal detachment developed in 3 eyes (%5.4), postoperatively. After a median follow-up of 4 months postoperative best corrected visual acuity (BCVA) was 20/40 or better in 10 patients (18.2%). Lower rate of postoperative intraocular pressure higher than 25mmHg was present in eyes operated between 1 week and 1 month after cataract surgery (Chi-square test, p<0.02). Eyes with posterior chamber intraocular lenses (IOL) also had better corrected postoperative visual acuity than aphakic eyes. Retinal detachment was the major factor in the eyes with visual acuity of equal or less than 20/400 and accounted for 7 eyes (29.2 %)( 4 of 6 cases with RRD preoperatively had redetachment and 3 new cases with RRD postoperatively) . Conclusion: The timing of vitrectomy was not found to be a factor affecting the final visual acuity (p>0.05, Chi-square test). Accompanying retinal pathologies are the most important factors that affect postoperative success. [ABSTRACT FROM AUTHOR]

A 32-year-old man presented with bilateral diminution of vision for 10 years. Visual acuity was light perception in both eyes with inaccurate projection in the oculus dextrus(OD) and accurate projection in the in oculus sinister (OS). Intraocular pressure was 6 and 12 mm Hg in the OD and OS, respectively. Slit-lamp examination revealed the presence of leucomatous corneal opacification with microcornea in oculus uterque (OU). Both eyes had a dislocated nucleus in the vitreous cavity on ultrasound B-scan with advanced cupping in the right eye. Ultrasound biomicroscopy revealed ciliary body atrophy in the OD and preserved ciliary processes (two quadrants) in the OS. In view of a partially preserved ciliary body function and a potential for gaining useful vision, we planned surgical intervention in the left eye. Deep anterior lamellar keratoplasty with pars planavitrectomy (PPV) and phacofragmentation of the nucleus was done. Donor lamellar graft was sutured after completion of PPV and nucleus fragmentation. The patient regained useful ambulatory vision postoperatively with clear corneal graft., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract: Background: Thirty six cases of lenticular nucleus drop following phacoemulsification and 43 cases of posterior dislocation of intraocular lens (IOL) inclusive of two paediatric cases were managed by a modified vitrectomy procedure without using perfluorocarbon liquid (PFCL). Methods: In these cases the incision was placed inferotemporally at pars plana. The limbal sites of the earlier cataract surgery were utilised as the other two ports. In either case adequate vitrectomy was performed first. In cases of nuclear drop, the nucleus was impaled (speared) with a micro vitreo retinal blade and brought into the anterior chamber from where it was delivered out. In cases of IOL drop the same was picked up by an intra-vitreal forceps. Result: Of the 77 adult cases treated 57 (74%) of the eyes had a visual recovery of 6/18 or more. Conclusion: Prompt surgical management in cases of nuclear drop or posterior dislocation of IOL yields good results. [Copyright &y& Elsevier]