Cataract Surgery - Retained Lens Material 

Introduction

In some cases, a cataract cannot be removed completely with surgery and some of the lens material remains in the eye.  If the amount of retained lens material is small, it may dissolve.  If there is a large amount of lens material, elevated pressure, or severe inflammation, a second procedure, called a vitrectomy, can remove the lens material and help restore vision. 

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Anatomy
The sclera is the white part of your eye.  The sclera is a tough protective coat that covers most of your eye.  It is composed of several layers and contains numerous blood vessels.  Light rays enter the front of your eye and are interpreted by your brain as images.  Light rays first enter your eye through the cornea, the “window” of your eye.  The cornea is a clear dome that helps your eyes focus.
 
The anterior chamber is located behind the cornea and in front of the iris.  The anterior chamber is filled with a fluid that maintains eye pressure, nourishes the eye, and keeps it healthy.  The iris is the colored part of your eye. The pupil is the black circle in the center of your iris.  It changes size to allow more or less light to enter your eye.
 
After light comes through the pupil, it enters the lens.  The lens is a clear curved disc.  The ciliary muscles adjust the curve in the lens to focus clear images on the retina.  The retina is located at the back of your eye.
 
Your inner eye or the space between the posterior chamber behind the lens and the retina is the vitreous body.  It is filled with a clear gel substance that gives the eye its shape.  Light rays pass through the vitreous humor on their way from the lens to the retina.
 
The retina is a thin tissue layer that contains millions of nerve cells.  The nerve cells are sensitive to light.  Cones and rods are specialized receptor cells.  Cones are specialized for color vision and detailed vision, such as for reading or identifying distant objects.  The greatest concentration of cones is found in the macula and fovea at the center of the retina. 
 
The macula is the center of visual attention.  The fovea is the site of visual acuity or best visual sharpness.  Rods are located throughout the rest of the retina.
 
Rods perceive blacks, whites, and grays, but not colors.  They detect general shapes.  Rods are used for night vision and peripheral vision.  The receptor cells in the retina send nerve messages about what you see to the occipital cortex in the brain, where you process and perceive vision.

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Causes
Cataracts are a common condition among older adults.  A cataract is a cloudy area in the lens of the eye.  Cataracts do not need to be removed unless vision loss interferes with daily activities.  Cataract surgery involves surgically removing the lens in the eye and replacing it with an artificial one.
 
In some cases, the lens cannot be removed completely and some of the lens is left in the eye.  Small amounts of retained lens material may dissolve.  Large amounts of lens material may need to be removed.  The eye may develop problems with increased pressure or severe inflammation.  A surgical procedure, called a vitrectomy, is used to treat such complications following cataract surgery.

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Symptoms
Symptoms from retained lens material, inflammation, and increased intraocular pressure typically occur within a few days of the cataract surgery.  You may experience eye redness, pain, and sensitivity to light.  Your eyes may produce more tears than usual.  Your may see floaters or specs in your field of vision.  Your vision may decrease.  Decreases in vision may vary from mild to extreme.

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Diagnosis
Following cataract surgery, your doctor will monitor your healing process closely.  You should tell your doctor about any symptoms you experience.  Your doctor will evaluate any lens material that is left in your eye following your surgery and check your eye for increased pressure or inflammation. 
 
Your doctor will dilate your pupils and view your inner eye structures.  Tonometry is used to measure the pressure in your eyes.  A visual acuity test is used to determine how well you see at different distances.  Imaging tests may be used to produce pictures of your inner eye.  Ultrasound, also referred to as echography, uses high frequency sound waves to produce images of the internal eye structures.

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Treatment
Vitrectomy may be necessary to remove the remaining lens material and help restore vision.  The microsurgical procedure involves making tiny incisions in the sclera and using suction to remove the lens material from the eye.  Vitreous gel from the back of the eye is also removed.  This cleans out the entire lens material, inflammation, and debris.  The eye is filled with a special salt water solution.  An artificial lens may be placed in the eye during the vitrectomy.  The placement of an existing lens may be adjusted. 
 
Following surgery, your vision will be blurry while your eye heals.  Your doctor will monitor your recovery closely.  Most people experience good outcomes after vitrectomy.

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Complications
Complications, if treated in a timely fashion are few.  You may have swelling of the macula called macula edema due to the inflammation that was present.  This can be treated with medications but will delay the return of vision in your eye.  Retinal detachment is a possibility but is uncommon following the vitrectomy, with an incidence of about 1%.  As with any surgery there is a small risk of infection occurring in about one in a thousand patients.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.