Purpose:

Aim of this video is to show a technique to remove a dislocated lens from the vitreous cavity using pars plana vitrectome. The author of this video suggests that this technique is more safe and convenient than generally used techniques using endo fragmentor or vitrectome.

Methods:

The video presents a case of 60-year-old women with non-penetrating injury to her right eye with complete zonulolysis and crystalline lens dislocation in vitreous cavity. The author decided extract the lens using 23G pars plana vitrectomy. He inserted 3 23G PPV ports 3mm behind the limbus. One as an irrigation port, one as a port for vitrectome, one as a port for endoillumination. After core vitrectomy and deliberation of the crystalline lens he decided not to use conventional technique of cutting by vitrectome which is usually accompanied by pursuing of multiple pieces of lens fragments on the surface of retina. Instead he inserted 4th 23G PPV port and used a 27G needle to puncture the lens exactly in the center. The needle creates the axis of rotation. Placing the vitrectome on equator of the lens with adjusted vacuum level and cutter rate we are able to start turning the lens around the needle as an axis of rotation without any floating and minimum dropping lens remnants on retina.

Results:

The turning technique for crystalline lens extraction used in this case of traumatic crystalline lens dislocation in vitreous cavity was accompanied by minimum floating and dropping lens fragments compared to the conventional technique, and postoperatively was without any anatomical or functional defect on retina.

Conclusion:

Dislocation of crystalline lens in the vitreous whether traumatic or iatrogenic will be always a challenge for any eye surgeon. Generally there are three options how to deal with this case a) ultrasound endo fragmentation in the vitreous cavity b) elevation to anterior chamber using PFCL c) cut the lens by vitrectome in the vitreous cavity. Removing the lens from anterior segment is delicate procedure, but from posterior segment even more. After any eye trauma there is high chance that the retina is affected. We have to look for technique that will not increase the risk of harming this delicate structure. Using ultrasound energy of endo fragmentor is sometimes necessary in case of hard nucleus. However, the retina is exposed to high levels of energy transmitted from endo fragmentor. Using heavy liquids (PFCL) for elevating lens has its economic disadvantage, but is the method of choice in cases of extremely hard nucleus with combination of intracapsular extraction in toto. Using vitrectome for soft to medium hard lenses is good option with the goal of maximally avoiding contact with retina. The author also believes that the turning technique is the best solution, especially for soft to medium hard lenses, in cases of dropped nucleus or crystalline lens in the vitreous cavity.