Phacoanaphylaxis Follow-up

Updated: Jun 14, 2016
  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Follow-up

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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