Retrait par vitrectomie postérieure de fragments nucléaires luxés en cours de phakoémulsification: Incidence, facteurs de risque et pronostic du décollement de rétine postopératoire

Introduction: Dislocated nuclear fragments during phakoemulsification are a well-known complication. The treatment is often surgical, and serious complications, among which a retinal detachment may occur. The purpose of this study was to evaluate its incidence, risk factors, and prognosis. Methods: This retrospective study included a consecutive series of 24 eyes undergoing posterior vitrectomy for dislocated nuclear fragments during phakoemulsification. The main outcome measures were the postoperative retinal detachment (incidence, risk factors, prognosis). Results: Two retinal detachments occured after vitrectomy, an incidence of 8%. In both cases, a significant inflammation of the anterior chamber and corneal decompensation were noted before vitrectomy. More than 50% of the nucleus was dislocated. Intraocular implant manipulation did not intervene in either case. Two tears occured during vitrectomy in one case. The prognosis of the detachment, with proliferation, was poor in both cases. Discussion and conclusion: The high incidence of retinal detachment compares with that observed after phakoemulsification complicated by vitreous loss. Anterior segment deterioration, which compromises posterior segment visualization, and dislocation of more than 50% of the nucleus, that increases the risk of fragments falling on the retina during vitrectomy, may increase the occurrence of retinal detachment with a poor prognosis because of periretinal proliferation.