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Impressum
"Crushing"- a safe and effective method for the removal of the dropped nucleus
Gerding H.
Dept. of Ophthalmology, Universitätsklinikum Münster, Domagkstr. 15, 48129 Münster, Germany
Background: Analysis of the intraoperative situation and postoperative
follow-up in patients with dropped nuclei which were removed from the
vitreous cavity solely by using the technique of lens crushing.
Material and Methods: 16 patients (8 females, 8 males) were enclosed
in whom surgery was performed between January 1997 and December 2000.
The size of dropped nucleus was ranging from 20-100 % (median: 85 %).
In 9/16 surgery was combined with secondary IOL implantation (sulcus based).
After "core-vitrectomy and careful inspection of the vitreous base
(transscleral illumination) nuclei were fragmented by squeezing them between
vitreous cutter and light pipe and subsequently removed with increased
suction performance. Follow-up covered a period between 3 and 21 months.
Results: Intraoperative: In all cases a complete removal of nucleus
material was achieved without complications. The method allowed an easy
approach even in the three oldest patients of the study group (between
80 and 86 years of age). Time necessary for the complete surgical procedure
ranged from 35 to 105 minutes (median: 59.9 minutes). Postoperative: Considerable
improvement of visual acuity was achieved in all patients. Retained lens
particles were not found in any case. Preoperative symptoms (deteriorated
vision, elevated intraocular pressure and inflammation) was persisting
for more than 7 days in only four patients (mainly with delayed referral).
One case presenting with retinal detachment five weeks after dismission
had a successful buckle procedure.
Conclusions: "Crushing"-technique allows an easy to use
and low risk removal of dropped nucleus material from the vitreous cavity.
It is a versatile and available method in all units providing the normal
equipment for standard vitreoretinal procedures. The method is applicable
even to relative hard nuclei.