23-Gauge Pars Plana Vitrectomy Alone by a Bimanual Technique for the Removal of Dense Posteriorly Dislocated Crystalline Lens

Background: We sought to verify the efficacy and safety of transconjunctival 23-gauge pars plana vitrectomy (PPV) alone by our bimanual technique for the removal of dense posteriorly dislocated crystalline lens. Methods: A retrospective, noncomparative, interventional study of 31 consecutive cases of patients who underwent 23-gauge PPV alone for the removal of dense posteriorly dislocated crystalline lens following complicated cataract surgeries using our bimanual technique was conducted. The main outcomes measured included best-corrected visual acuity (BCVA), preoperative intraocular pressure (IOP), postoperative IOP and postoperative complications. Results: In all 31 cases included in this study, those dense posteriorly dislocated crystalline lenses were successfully removed. The enrolled patients consisted of 17 males and 14 females with a mean age of (75.84 ± 6.17) years (range 59 - 90). The mean follow-up length was (7.61 ± 1.87) months with a range of 6 months to 1 year. The mean preoperative BCVA was 0.22 ± 0.11 logMAR system, and the postoperative BCVA was 0.33 ± 0.07 logMAR system after 6 months of follow-up. The mean operative time was 46.32 ± 4.80 minutes with a range of 38.00 to 57.00 minutes. All of the conjunctival incisions self-closed within the first week with no wound leakage or hemorrhage. The postoperative complications were relatively rare. Conclusions: The removal of dense posteriorly dislocated crystalline lens might be a challenge for micro-incision vitrectomy. Our bimanual technique was proved to be an effective and safe method for those particular dense lenses using 23-gauge alone.