While most cases of vitreous prolapse during a complicated cataract surgery can be effectively address via limbal incisions, there are times when a pars plana approach is better. In this case, the patient had prior cataract surgery and the single-piece acrylic IOL has slipped through a damaged capsule and is now in the anterior vitreous. A limbal approach would prove to be difficult and may even result in the IOL being displaced deeper into the vitreous cavity.
In this case we also do the twist technique to explant the single-piece acrylic IOL via an incision of about 3 mm without using special instruments. And if you look carefully, you will notice that we also use the vitrector to perform a small peripheral iridotomy in this case.
The pars plana approach does require more planning and extra steps such creating and closing a scerlotomy and then carefully checking for entry site breaks. Certainly, any time that we perform a vitrectomy whether anterior or posterior, there is a higher risk for retinal complications such as vitreous traction, retinal breaks/detachment, macular edema, and even endophthalmitis. These patients must be watched carefully in the post-op period and if you are uncomfortable with this higher level of care, it often is best to refer the patient to a vitreo-retinal colleague so that you can do a team approach.
Click below to learn from this video of pars plana anterior vitrectomy and IOL retrieval:
