Vineeth Balakri Kumar, MD (Wirral, UK), Ronnie Bhola, FRCS(ophth) (Sheffield, UK), Stephen Winder, MD (Sheffield, UK), Richard Sheard, MA, FRCOphth (Sheffield, UK)

PURPOSE:

To identify:
1. Visual outcomes,
2. Complications,
3. Primary or Secondary IOL implantation,
4. Difference between poorly managed anterior segment and well managed anterior segment at referral in patients with dropped nucleus and coexisting retinal pathology.

METHODS:

This was a retrospective case note review of 28 case notes of patients referred to Vitreoretinal Unit, Royal Hallamshire Hospital, Sheffield The cases were managed by 2 Vitreoretinal surgeons. All patients underwent Vitrectomy, removal of nuclear fragment with fragmatome, internal search, IOL implantation and treatment of retinal pathology as
appropriate. Visual acuity was measured using snellen visual acuity charts.

RESULTS:

15 patients were found to have retinal pathology which was treated with either cryotherapy/gas tamponade 22 of the 28 (79%) patients achieved a visual acuity of 6/12 or better 8 patients had complications (1 had retinal detachment, 2 had IOL subluxation/ dislocation, 1 had corneal decompensation, 4 patients had postoperative Cystoid macular oedema) 20 patients had primary IOL implantation and 7 had secondary IOL, 1 patient had no IOL. 15 patients presented with anterior segment problems.13 of these patients had visual acuity of 6/12 or better postoperatively. 9 of these 15 patients with anterior segment
problems had coexistent retinal pathology which was treated successfully.

CONCLUSION:

Dropped nucleus and coexisting retinal pathology can be difficult to manage. Our experience has shown that although difficult to manage, if careful examination and treatment is undertaken complications can be prevented. No difference in visual outcomes or complications, for the poorly managed or well managed anterior segment problems was evident from our series.