The document discusses management of dropped nuclei and intraocular lenses during cataract surgery. It explains that a dropped nucleus or IOL can occur due to surgical trauma, pre-existing defects, extension of capsulorhexis, or zonular dehiscence. Any nucleus fragments should be removed to prevent inflammation and rise in pressure. If the anterior capsule is intact, an IOL can be placed, otherwise an anterior chamber or iris-claw IOL is required. Dropped IOLs should be removed if causing visual disturbances or retinal defects. Surgical techniques for removing fragments and IOLs include vitrectomy and placement of a secondary IOL such as scleral-fixated or glued IOL

1. Eye Care & Management
Insights for better sight.
Dr Nitin Prabhudesai

2. Management of Dropped Nucleus & IOL
Dr Nitin Prabhudesai

3. Why the Nucleus Drop Occurs?
• Rent in the Posterior Capsule
– Surgical Trauma
– Pre existing traumatic defect,
Needle touch
– Polar cataract
• Extension of Capsulorhexis
• Zonular dehiscence
• Pseudoexfoliation
Dr Nitin Prabhudesai

4. Why the IOL Drop Occurs
Dr Nitin Prabhudesai

5. When to Remove Dropped Nucleus
Dr Nitin Prabhudesai
• Ideally any amount of dropped nucleus
should be removed
• Most Nuclear fragments incite an
inflammatory reaction & rise in IOP
• No attempt to “Fish Out’’ the nucleus
hastily
• Anterior Vitrectomy with closure of
wound

6. Should IOL be placed ?
• If the Anterior Capsular rim is intact
IOL can be placed
• If Capsular support not adequate
– Anterior chamber IOL
– Iris claw IOL
Dr Nitin Prabhudesai

7. When to remove Dropped IOL
• Visual disturbances
• Retinal defects
Dr Nitin Prabhudesai

8. How to remove Nuclear Fragments
• 3 port Vitrectomy
• Fragmatome for larger & harder cases
• PFCL use to float the Nucleus
• Vitrectomy Cutter for softer cases
• Placement of IOL
• Secondary IOL
Dr Nitin Prabhudesai

9. Secondary IOL
• Choice of Secondary IOL after Primary surgery
– IOL on capsular rim
– Scleral Fixated IOL
– Glued IOL
Dr Nitin Prabhudesai

10. IOL removal
• 3 port Vitrectomy
• IOL removal
• Placement of secondary
IOL
Dr Nitin Prabhudesai

11. Dropped Nucleus
Presentation Video
Dr Nitin Prabhudesai

12. Dr Nitin Prabhudesai

13. Vitrectomy IOL Removal
Presentation Video
Dr Nitin Prabhudesai

14. Dr Nitin Prabhudesai

15. IOL Removal
Presentation Video
Dr Nitin Prabhudesai

16. Dr Nitin Prabhudesai

17. Thank you
Dr Nitin Prabhudesai