Dislocation of lens fragments into the posterior chamber is a well-known complication of cataract surgery. Pars plana vitrectomy (PPV) offers an effective means of removing retained lens material. For many years, 20-gauge instruments and ultrasonic fragmentation have been used to effectively remove lens fragments from the vitreous cavity. Over the past decade, as small-incision transconjunctival, sutureless PPV has gained increasing popularity, surgeons have employed these techniques for an expanding number of indications. Both 25-gauge and 23-gauge systems have been used to remove retained lens fragments, but certain cases with dense nuclear material still require a 20-gauge sclerotomy to facilitate the use of an ultrasonic fragmatome. The use of a single 20-gauge superior sclerotomy and 2 23-gauge ports, namely 1 superior port for endoillumination and 1 inferotemporal port for infusion, has been previously described for a variety of surgical indications.

Kiss and Vavvas first described the surgical management of 3 patients with retained lens material using 25-gauge PPV. These patients all had retained cortical material, whereas 3 other patients with retained nuclear material required 1 20-gauge port and a fragmatome to remove lens fragments. Recently, Ho and associates also looked at 25-gauge PPV for removing retained lens material. They reported 17 patients with retained lens material who were all successfully managed with 25-gauge PPV alone, including 13 cases with nuclear material. To our knowledge, there are no reports in the literature describing the use of 23-gauge PPV to remove retained lens material. The aim of the current retrospective study is to examine the usefulness of 23-gauge PPV in removing retained lens material and to determine which cases are most amenable to 23-gauge PPV without ultrasonic fragmentation vs 20-gauge PPV with fragmentation.