Risk factors for and management of dropped nucleus during phacoemulsification

PURPOSE: To study the risk factors and management of posteriorly dislocated crystalline lenses during phacoemulsification at a teaching institution. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This retrospective analysis included all phacoemulsification procedures performed by experienced and inexperienced surgeons over 7 years. The incidence, risk factors for, role of surgical experience, mode of management, and the final outcome of posteriorly dislocated lens nuclei were evaluated. RESULTS: Of a total 11 343 phacoemulsification procedures performed between 1993 and 1999, the nucleus was dropped in 38 eyes (0.3%). Two patients with a dropped nucleus were referred from an outside practice. The incidence of dropped nucleus with experienced surgeons (22/8671; 0.2%) was significantly less than that with inexperienced surgeons (16/2672; 0.6%) (P =.007). Sixteen of the 22 cases of dropped nucleus (72.7%) in the experienced group and 1 of 16 (6.3%) in the inexperienced group had risk factors (P =.0005). Nucleus removal was performed using vitreoretinal procedures in 39 eyes; 1 eye with a dropped epinucleus was managed conservatively. The final best corrected visual acuity was 20/40 or better in 21 eyes (53.8%). CONCLUSIONS: The incidence of dropped nucleus was more frequent with inexperienced surgeons, even though experienced surgeons had more cases with predisposing risk factors. Modern vitreoretinal procedures reduce morbidity and improve the visual outcome.