The aim of this study is to investigate the intraoperative detection characteristics of occult peripheral retinal lesions and clinical treatment effects of pars plana vitrectomy (PPV) in patients with lens dislocation.

A total of 60 patients, 60 eyes, with lens dislocation who underwent surgical treatment in the Department of Ocular Trauma, Beijing Tongren Hospital Affiliated with Capital Medical University, from April 2024 to April 2025 were collected. Among them, 50 patients (50 eyes), were male and 10 patients (10 eyes), were female. The patients were 29 to 77 years old, with a mean age of 58.0±9.0 years. A 25 G transscleral three-port approach was established in all cases. According to the extent of lens dislocation, capsular support, and lens nucleus hardness, phacoemulsification combined with anterior vitrectomy or lensectomy combined with subtotal or complete vitrectomy was performed. Intraoperative 360° peripheral retinal examination with scleral indentation was performed in all eyes. Preoperative and postoperative uncorrected visual acuity, intraocular pressure, types of occult peripheral retinal lesions, and corresponding intraoperative management were recorded. For measurement data including age, uncorrected visual acuity and intraocular pressure, normality was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were expressed as ±s, and preoperative and postoperative values were compared using the paired t-test. Categorical variables such as gender, lens dislocation cause, dislocation degree and presence of anterior chamber vitreous prolapse as well as detection status of intraoperative occult peripheral retinal lesions were expressed as cases (eyes) and percentages, and Pearson chi-square test was used for intergroup comparison. Univariate Logistic regression analysis was performed to identify factors associated with the detection of occult peripheral retinal lesions. Significant variables were incorporated into the multivariate binary Logistic regression model to screen independent risk factors for the occurrence of the lesions.

Among the 60 eyes, 14 cases (14 eyes), 23.3%, underwent phacoemulsification combined with anterior vitrectomy, and 46 cases (46 eyes), 76.7%, underwent lensectomy combined with subtotal or complete vitrectomy. Occult peripheral retinal lesions were detected in 32 cases (32 eyes), 53.3%, including retinal breaks in 7cases (7 eyes), 11.7%, peripheral retinal degeneration in 21 cases (21 eyes), 35.0%, ora serrata dialysis in 2 cases (2 eyes), 3.3%, and localized shallow retinal detachment in 2 cases (2 eyes), 3.3%. Intraoperative retinal photocoagulation was performed in 44 cases (44 eyes), 73.3%, and intravitreal air tamponade was performed in 8 cases (8 eyes), 13.3%. In-the-bag intraocular lens implantation combined with capsular tension ring implantation was performed in 14 cases (14 eyes), 23.3%; intrascleral intraocular lens fixation was performed in 35 cases (35 eyes), 58.3%; ciliary sulcus suture fixation was performed in 8 cases (8 eyes), 13.3%; and 3 cases (3 eyes), 5.0%, were left aphakic. The preoperative uncorrected visual acuity was (1.55±0.54) logMAR, and the postoperative uncorrected visual acuity was (0.87±0.73) logMAR. The difference was statistically significant (t=7.215, P<0.05). The preoperative intraocular pressure was (17.6±6.8) mmHg (1 mmHg=0.133 kPa), and the postoperative intraocular pressure was (13.8±3.9) mmHg. The difference was statistically significant (t=5.102, P<0.05). Multivariate binary Logistic regression analysis showed that age ≥60 years, traumatic lens dislocation and complete lens dislocation were independent risk factors for occult peripheral retinal lesions (OR=3.197, 4.158, 3.334, 95%CI: 1.001 to 10.212, 1.182 to 14.617, 1.005 to 11.067; P<0.05).

A relatively high proportion of occult peripheral retinal lesions can be detected intraoperatively in patients with lens dislocation, suggesting that routine preoperative examination may underestimate posterior segment risk. Intraoperative 360° peripheral retinal examination should be emphasized, particularly in older patients and those with traumatic lens dislocation, complete lens dislocation, or limited preoperative fundus visualization. Systematic intraoperative exploration with scleral indentation can facilitate timely detection and management of retinal breaks, ora serrata dialysis, localized shallow retinal detachment, and high-risk peripheral retinal degeneration, and may help reduce the risk of postoperative retinal complications.