Vitreous loss is connected with a poor visual result following cataract surgery. Vitreous loss is less common among experienced surgeons and those who undertake a significant volume of cataract surgeries. Risk classification techniques exist to assist less experienced surgeons in avoiding high-risk patients. The treatment of vitreous loss entails counseling patients about the possible risks and problems prior to the cataract surgery.
When a vitreous loss occurs, it is critical for the surgeon to avoid behaviors that enhance the likelihood of an eye tragedy. These include phacoemulsification in the presence of vitreous and non-vitrectomy methods to retrieve lens pieces from the posterior region.
There are advantages to conducting an anterior vitrectomy via the pars plana pathway rather than the anterior chamber, and sutureless 23-gauge tools aid this method. Lens nuclear fragment dislocation into the vitreous is associated with an increased risk of retinal detachment, subsequent glaucoma, and cystoid macular edema. It is suggested that these eyes be managed promptly by a retinal surgeon.
The posterior lens capsule is an anatomical barrier that protects the vitreous body from lens fragmentation, aspiration, and intraocular lens implantation stresses. In the 1997–1998 UK national cataract surgery study, capsule rupture and vitreous loss occurred in 4.4 percent of patients. Other papers indicate rates ranging between 8.22 and 0.45 percent of patients. Vitreous degeneration is associated with an increased risk of vision-threatening consequences such as cystoid macular edema, retinal detachment, and endophthalmitis. 2, 3, 4, 5, 6, 7 Disruption of the posterior capsule may be followed by displacement of lens pieces into the posterior segment, resulting in an even poorer prognosis for those eyes.
Prevention
The nitty-gritty of safe cataract surgery is beyond the scope of this essay and is covered in current literature.
Vitreous loss is dependent on the surgeon’s experience,6 surgical volumes (number of cataract procedures performed per surgeon per year),12, 13, and the complexity of cases or case-mix. Scoring systems enable a quantifiable estimate of risk in individual instances prior to the cataract surgery. Such risk categorization enables difficulties to be predicted and avoided via proper patient preparation, anesthetic type, and surgeon selection. Muhtaseb has shown that even experienced consultants had an 8% vitreous loss rate and a 4% fallen lens nucleus rate in high-risk eyes. Cataract surgery in such eyes appears to be best performed by surgeons skilled in vitrectomy and the removal of displaced lens components from the posterior region.
While the critical role of the capsulorhexis in the outcome of cataract surgery has been correctly stressed17, the quality of the capsulorhexis may be established much earlier in the operation by factors such as patient preparation, anesthetic choice, and wound architecture. Difficulties may arise even with flawless capsulorhexis in high-risk eyes, such as after vitrectomy18, when an unstable anterior chamber depth results in anterior chamber depth variations, pupil constriction, and patient discomfort. 19 It is necessary to understand how to manage these eyes.
The patient’s management
Cataract surgery is not a routine procedure, but people have come to expect it to be. If informed consent included a discussion of anticipated vitreous loss, lens matter displacement, and failure to implant an intraocular lens, managing a substantial intraoperative complication will be easier for the patient. This will alleviate patient anxiety and contribute to the patient and surgeon developing trust during and after the cataract surgery procedure. Patients want to be advised of uncommon consequences; 93.5 percent want to be notified if the risk is one in 50, and 62.4 percent want to be informed if the risk is one in 1000. However, recall accuracy of consent information is low, particularly for significant problems, creating a barrier in preparing patients for potentially problematic operations.
Management: the watchful eye
Recognition of vitreous loss will be indicated by a slight but abrupt change in the internal circumstances of the eye. One or more of the following signs may be observed: sudden chamber deepening, altered lens nucleus mobility, excessive sideways displacement of the nucleus, the sudden appearance of a red reflex, and abnormal movement of structures (for example, the pupil margin) remote from instruments in the anterior chamber caused by traction transmitted through vitreous strands. You can read about Things you shouldn’t dare to do after cataract …
