Dropped Nucleus - Management of

Publication: 31/03/2002  
Next review: 01/08/2025  
Standard Operating Procedure
CURRENT 
ID: 455 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Management of the "dropped nucleus"

Following Mr Woon's audit on the 5th Feb 2002 the following guidelines apply to patients with dropped nuclear fragments at time of cataract surgery:

  1. Do not go after the dropped fragments. If it is accepted that the patient will need further surgery to retrieve lens fragments from the posterior segment, then do the minimum required to allow the eye to be closed up. Extensive further surgery in the anterior segment may cause further loss of posterior capsule or corneal oedema which could prevent prompt vitrectomy.

  2. Management of vitreous loss is best done with a closed system. Attempting to perform an anterior vitrectomy through an unsecured phaco-incision may lead to shallowing of the anterior chamber and endothelial trauma. Care should also be taken to preserve as much lens capsule as possible. Insufficient lens capsule making IOL implantation difficult will mean that the patient needs 2 further operations instead of one. Some anterior segment surgeons advocate the use of pars plana sclerostomy together with an AC maintainer to perform an anterior vitrectomy. This has the advantage of ensuring a closed system and of drawing the vitreous posteriorly and away from the corneal wound.

  3. Intraocular lens placement is optional. Defer intraocular implantation if it is likely to be difficult and lead to corneal trauma. Use of large amounts of healon during an anterior vitrectomy/IOL implantation may produce a severe post operative pressure rise it then becomes difficult to remove the healon.

  4. Avoid prolonged further procedures on a patient if they are uncomfortable. This is a major source of complaint.
     
  5. Start all patients on Diamox 250 mg bd if it is suspected that the intraocular pressure may rise and if there are no contraindications.

  6. Intensive topical steroids such as guttae Prednisolone forte 1% 2 hourly and guttae Chloramphenicol 0.5% qds should be given to all patients.

  7. Do not give oral steroids.

  8. Review the patient the following day to assess the patient and decide on need for oral acetazolamide. Appropriate management and monitoring of inflammation and glaucome should be institued. The complication should be discussed with the patient who should then be referred prompty to retinal surgeons within a few days.

  9. Please make sure to enclose the biometry data to assist retinal surgeons implant a secondary lens or exchange lens if necessary.

  10. It is important to have a full and honest discussion with the patient of the nature of the complication.

Provenance

Record: 455
Objective:
Clinical condition:
Target patient group: All
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

N/A


Evidence base

Not supplied

Document history

LHP version 1.0

Related information

Not supplied

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