Phacoanaphylaxis Follow-up

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

Further Outpatient Care

  • Follow-up care of patients with phacoanaphylaxis or retained lens material should be scheduled according to the severity of symptoms and the preoperative or postoperative condition of the patient.
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Complications

  • Cystoid macular edema: The incidence of cystoid macular edema after complicated cataract surgery with retained lens material has been reported to be approximately 7%.[26, 80]
  • Secondary glaucoma
    • The incidence of secondary glaucoma related to retained lens fragment was 30% in one study and 52% in another study.
    • Leakage of lens proteins through the injured lens capsule with or without leakage of serum proteins from uveal blood vessels in lens-induced uveitis may block the trabecular outflow causing secondary glaucoma.[27]
    • Trabecular meshwork obstruction may occur with the accumulation of white blood cells (macrophages and activated T lymphocytes) or their aggregations. These may cause peripheral anterior synechiae and subsequent closed-angle glaucoma.
    • Obstruction may arise from inflammatory debris (eg, proteins, fibrin, high molecular weight proteins) and from lens particles. These proteins increase the aqueous viscosity, which may contribute to increased intraocular pressure.
  • Retinal detachment
    • The incidence of retinal detachment after cataract surgery complicated by retained lens material is 7-11%. This is not a result of damage to the retina from sharp lens fragments or the inflammation associated with phacoanaphylaxis but is related to complications of the cataract surgery, such as vitreous loss.
    • Vigorous attempts to retrieve the lens fragments from the vitreous cavity via an anterior segment incision during phacoemulsification have been associated with giant retinal tears and poor prognosis.[81]
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Prognosis

  • Prognosis of phacoanaphylaxis without surgical treatment is dismal. With appropriate surgical and medical treatment, the prognosis of retained lens material is much more favorable, especially with today's state-of-the-art surgical techniques.
    • Several series reported visual acuities of 20/40 or better in 60-82% of patients with retained lens material after vitrectomy.[79]
    • Postoperative complications related to vitrectomy may be difficult to distinguish from complications related to the initial cataract surgery. (See Surgical Care.)
    • The prognosis in trauma cases is highly correlated to the extent of trauma and the visual acuity at the time of initial evaluation.
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Contributor Information and Disclosures
Author

Robert H Graham, MD  Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society

Disclosure: WebMD/eMedicine Salary Employment

Coauthor(s)

Charles C Barr, MD  Retina Service Director, Professor, Department of Ophthalmology, University of Louisville School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John D Sheppard Jr, MD, MMSc  Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Judith Mohay, MD, to the development and writing of this article.

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Gross photomicrograph for eye enucleated with penetrating injury.
Gross photomicrograph for eye enucleated with penetrating injury. Note marked inflammatory reaction consisting of polymorphonuclear cells around lens capsule and lens fibers (hematoxylin and eosin X100).
Low (X25) photomicrograph of phacoanaphylactic reaction to lens protein in eye enucleated with penetrating injury. Note polymorphonuclear leucocytes around lens protein (hematoxylin and eosin).
High (X50) photomicrograph of phacoanaphylactic reaction to lens protein in eye enucleated with penetrating injury. Note polymorphonuclear leucocytes around lens protein (hematoxylin and eosin).
Phacoanaphylactic reaction to penetrating injury of lens. This patient was a 25-year-old woman whose eye was penetrated with a 27-gauge needle during an attempt to anesthetize the eyelid for chalazion removal. One week later, a marked uveitis was present. Notice perforation site and posterior synechiae.
Same patient as in Media file 5. Notice cortical cataract at perforation site.
Typical clinical picture of retained lens material following cataract surgery. White cortical material is easily visible in the pupillary space.
Patient with persistently elevated intraocular pressure after cataract surgery was found to have retained lens material and low-grade inflammation. Eye is white and quiet with anterior chamber lens.
Patient with persistently elevated intraocular pressure after cataract surgery was found to have retained lens material and low-grade inflammation. Retained lens material is visible in retroillumination on downgaze.
Typical appearance of retained lens fragments in posterior vitreous cavity. Lens material is a whitish substance that obscures fundus details.
Another view of a retained lens fragment, noted inferiorly.
 
 
 
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