Effect of Timing of Pars Plana Vitrectomy on Visual Outcome in Cases of Nucleus Drop during Phacoemulsification.

Purpose: The purpose of the study was to study the relationship between the timing of pars plana vitrectomy (PPV) with corrected distance visual acuity (CDVA) in cases of nucleus drop during phacoemulsification.

Methods: This retrospective analysis included 83 patients, who underwent PPV for nucleus or nuclear fragment drop from July 2017 to November 2019. Timing of PPV (≤2 weeks and >2 weeks) after the primary cataract surgery was noted. The primary endpoint was CDVA at 1 month, which was compared with the time of PPV. Visual outcome was assessed as good if CDVA was better than or equal to 20/40 and poor if CDVA was worse than 20/40. Mode of management along with type of secondary intraocular lens (IOL) implanted was also evaluated.

Results: Out of the 83 cases (55 males and 28 females) in which vitrectomy for nucleus drop was performed, 36 cases were operated within 2 weeks and 47 were operated between 2 weeks and 1 month. In cases which were operated within 2 weeks, CDVA of 20/20-20/40 was achieved in 33 cases. For those who were operated on after 2 weeks, CDVA of 20/20-20/40 was achieved in 43 cases. The difference in visual outcome in both the groups was statistically nonsignificant (Fisher's exact t-test, P = 0.97). In 64 (77%) cases, adequate sulcus was present, in which foldable 3-piece IOL was placed in 29 (35%) cases.

Conclusion: Timing of intervention has no bearing on the final visual outcome after vitrectomy in cases of nucleus drop during phacoemulsification. The continuity of the capsulorrhexis and the availability of capsular support determines the type of placement of the lens. A foldable lens can be placed in the sulcus if continuous capsulorrhexis is present.