Phacofragmentation for the treatment of a completely posterior dislocation of the total crystalline lens

In order to evaluate the effectiveness and safety of intravitreal phacofragmentation, we analyzed cases of pars plana vitrectomy (PPV) with intravitreal phacofragmentation and scleral fixation of an intraocular lens (IOL) performed in patients with a crystalline lens completely dislocated into the vitreous cavity without any damage to the lens capsule. Of the 23 eyes examined, the dislocated lens was related with a hypermature cataract in 4 eyes and Marfan syndrome in 2 eyes, developed after argon and Nd:YAG laser iridotomy in 2 eyes, and was due to ocular trauma in 15 eyes. The dislocated lens was present for more than a year in 6 eyes and less than 4 weeks in 13 eyes. PPV, intravitreal phacofragmentation and scleral fixation of IOL were performed in all 23 eyes. Additionally, trabeculectomy was performed in 4 eyes, iridoplasty in 1 eye and cryopexy with intravitreal injection of sulfur hexafluoride in 2 eyes. Perfluorocarbon liquid was used in 9 eyes. The mean follow-up period was 11.7 months. On final examination, the visual acuity was better than 20/40 in 17 eyes (73.9%) and counting fingers in 1 eye due to traumatic optic neuropathy. There was no postoperative retinal detachment. These results demonstrated that PPV with intravitreal phacofragmentation and other combined procedures is a safe and effective surgical method for treating a completely dislocated crystalline lens.