What are the Retained Lens Material Treatment Options Following Cataract Surgery?

July 17, 2009

A recent article was released exclaiming that retained lens material (aka RLM) may be safely treated with medications versus vitrectomy surgery. The article defined three groups, all of which experienced RLM as a complication of cataract surgery.

The first group received vitrectomy within 1 week, the second group was initially managed with medical therapy, but underwent vitrectomy by the 2nd week due to failed control of inflammation, visual acuity or uncontrolled IOP. The third group was managed by medication alone.

The results indicate that visual acuity was similar in all 3 groups at 30 days and at one year.

What does this mean? I have difficulty understanding most of the comments. This was a retrospective study without any controls. The resulting vision was similar, but was not found to be great, that is, 65% had a vision of 20/40 or better.

Retained lens material, or RLM, is one of the most difficult cases to manage, not from a medical standpoint per se, but from a political and emotional view. From a retina specialists point of view, RLM occurs in every cataract practice and really isn’t a big deal to manage. From the cataract surgeons view, this is a major unnecessary complication. Many cataract surgeons view this as a statement of their surgical skills. Patients have no idea what may be going on.

As a result, there is tremendous anxiety regarding the cataract surgery and the resultant vision. The patient has to see a new doctor, can’t see and may need another operation. Even in the study, one criteria for operating was continued poor vision.

Emotions aside, medical considerations include controlling IOP and inflammation. Visual acuity, in my experience, usually returns nicely if the IOP/inflammation are not a problem. On the other hand, waiting too long, with uncontrolled IOP and inflammation, may cloud the cornea making eventual vitrectomy more difficult.

In the end, while medical management may be indicated, it will take lots of hand holding of the patient…and the cataract surgeon.

Randall V. Wong, M.D.
Retina Specialist
www.TotalRetina.com

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