Step 1 – Learn the basics of the eye and why some patients experience retained lens fragments following surgery
Step 2 – Learn about the surgery and what to expect
Step 3 – Learn about the other options
Step 4 – Learn about the potential risks of the procedure
Step 5 – Learn to maximize your results
The eye can be thought of as similar to a camera, with two main parts, a lens and a film. The lens is suspended within the eye by a delicate network of fibers called zonules. Age-related changes result in the lens becoming progressively cloudier, called a cataract. Behind the lens sits a gel called the vitreous. The vitreous lines the back wall of the eye and is very firmly adherent to the film layer of the eye, called the retina.
Cataract surgery refers to the removal of the natural lens and insertion of a clear artificial lens, called an intraocular lens. The training to become a cataract surgeon is rigorous, ensuring that all surgeons are outstanding in their field. None the less, some patients may have a very weak lens support structure which results in the natural lens of the eye falling backwards into the vitreous during cataract surgery. It is at this point that it is not typically safe for the cataract surgeon to proceed with removal of the remaining lens material, and the patient is sent to a retina specialist for a vitrectomy.
A pars plana vitrectomy with removal of retained lens fragments is an outpatient surgical procedure called a pars plana vitrectomy. It may be performed under under twilight (awake, relaxed, and painless) or general anesthesia.
The retina specialist places 3 small ports that are less than 0.5 millimeters in size through the white of the eye and into the vitreous cavity. Fluid is infused into the vitreous cavity while the surgeon uses a vitrectomy probe to carefully free the vitreous from any remaining lens fragments. The lens may be dense enough that a special instrument called a fragmatome must be used to break up the lens with ultrasound energy. The surgeon then carefully evaluates the eye to confirm there are no retinal tears. An eye patch and eye shield are placed on the eye. An intraocular lens may or may not be inserted into the eye at this time. The surgery is not typically painful. Tylenol is all that is needed for pain.
Patients whom have a very small amount of lens material without significant inflammation or high eye pressure may be candidates for observation, as opposed to surgical intervention. The surgeon will carefully weigh this option as a possibility.
The retina specialists who recommends the treatment will discuss the risks, benefits, and alternatives to the procedure. It is up to the judgement of the physician to weigh the benefit of the procedure to the potential risks. It is only once the decision is made that the benefits outweigh the potential risks is the procedure offered to the patient.
Pars plana vitrectomy with removal of lens material is typically able to remove all residual lens material, and result in an improvement in pressure and inflammation. Vision is typically very blurry until an intraocular lens is inserted into the eye. This is often done in a separate surgery by a cataract surgeon.
Pars plana vitrectomy with removal of lens material is a safe surgical procedure. There is a small risk of a retinal detachment or infection following surgery,
Symptoms of retinal detachment include the sudden onset of many new floaters, new onset flashing lights, or noting a progressive decrease in the peripheral vision (like a curtain coming down at a play). This is urgent and the treating physician should be made aware the same day.
There is a small risk of infection following the procedure. If this is going to occur, it typically occurs 3-5 days following the procedure. Symptoms include redness around the eye that gets worse not better, extreme light sensitivity, and worsening pain. This is a medical emergency and requires immediate treatment by a retina specialist.
The vision is typically very blurry the day following surgery. The vision thereafter will continue to improve, but may be limited until an intraocular lens is inserted into the eye.
Infection – The eye should continue feeling better following surgery. Infection is characterized by a combination of severe eye pain, profound light sensitivity, and a decrease in vision. This must be treated emergently.
It is important to use eye drops as prescribed by your retina specialist. Patients should ask if they need to continue to use prescription eye drops they were using prior to surgery.
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