We read with great interest the recent article by Modi and associates about the important and still controversial topic concerning the timing of pars plana vitrectomy for the management of nucleus drop.
The authors reported on a large case series of patients surgically treated at their institution for retained lens fragments, analyzing the visual outcomes and the rates of adverse events. We noticed that the authors used the corrected distance visual acuity at final follow-up for the analysis; given that there were some patients who were left aphakic, did the authors consider the visual acuity following the intraocular lens implantation performed in a further surgery, or were those cases excluded from the analysis?
We also observed that the authors pointed out how the correct timing of pars plana vitrectomy in these cases had remained controversial prior to their study. Respectfully, we highlight that their report unfortunately still does not provide definitive evidence, although they performed an analysis on a large sample. In fact, the authors might want to clarify the inclusion criteria adopted: did they operate on patients with dropped nucleus fragments smaller than a quarter of lens size or with epinucleus material retained in the vitreous cavity? If that was the case, were these patients with small fragments equally distributed among the 3 study groups? And can the authors analyze whether outcomes and complications were different in relation to the sizes and densities of the dropped lens material? For the delayed intervention, did the authors also base the indication for surgery on clinical conditions, such as excessive intraocular inflammation, elevated intraocular pressure, occurrence of cystoid macular edema, or decreased visual acuity? In addition, it is not clear whether the patients in the groups with delayed pars plana vitrectomy had received specific medical treatments prior to surgery.
Finally, it might be of interest to analyze whether there was any difference in the lengths of follow-up needed in cases undergoing immediate vs delayed vitreoretinal intervention.