Bimanual Technique used for removal of dense posteriorly dis
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Background
We sought to verify the efficacy and safety of transconjunctival 23- gauge pars plana vitrectomy (PPV) alone by our bimanual technique for the removal of dense posteriorly dislocated crystalline lens.

Methods
A retrospective, non- comparative, interventional study of 31 consecutive cases of patients who underwent 23-gauge PPV alone for the removal of dense posteriorly dislocated crystalline lens following complicated cataract surgeries using our bimanual technique was conducted. The main outcomes measured included best-corrected visual acuity (BCVA), preoperative intraocular pressure (IOP), postoperative IOP and postoperative complications.

Results
In all 31 cases included in this study, those dense posteriorly dislocated crystalline lenses were successfully removed. The enrolled patients consisted of 17 males and 14 females with a mean age of (75.84 ± 6.17) years (range 59 - 90). The mean follow-up length was (7.61 ± 1.87) months with a range of 6 months to 1 year. The mean preoperative BCVA was 0.22 ± 0.11 logMAR system, and the postoperative BCVA was 0.33 ± 0.07 logMAR system after 6 months of follow-up. The mean operative time was 46.32 ± 4.80 minutes with a range of 38.00 to 57.00 minutes. All of the conjunctival incisions self-closed within the first week with no wound leakage or hemorrhage. The postoperative complications were relatively rare.

Conclusions
The removal of dense posteriorly dislocated crystalline lens might be a challenge for micro-incision vitrectomy. Our bimanual technique was proved to be an effective and safe method for those particular dense lenses using 23-gauge alone.

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