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Pavlina Kemp, A. Johnson, James Folk, Stephen Russell, Vinit Mahajan, H Culver Boldt, Thomas Oetting, Elliott Sohn; Outcomes of Transpupillary Posterior Chamber Intraocular Lens Removal with Pars Plana Vitrectomy and Placement of Anterior Chamber Intraocular Lens. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5774.
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To evaluate visual results, intra-operative and post-operative complications in eyes needing pars plana vitrectomy (PPV) with transpupillary posterior chamber intraocular lens (PCIOL) removal and placement of anterior chamber intraocular lens (ACIOL).
We conducted a retrospective chart review on patients who underwent PPV for dislocated PCIOL and concurrent placement of ACIOL at the University of Iowa Hospitals and Clinics from 1/1/2007 to 11/1/2012. IRB approval was obtained. Detailed pre-, intra-, and post-operative data were compiled, and statistical analysis was performed.
14 patients (5 males, 9 females) met the inclusion criteria and were analyzed. There were 8 right eyes and 6 left eyes. The mean age at time of surgery was 82.6 years (median = 82, range 74 - 92). Mean visual acuity (VA) at time of surgery was 20/225 (median = 20/250). Mean VA at final visit until 9 months post-operatively was 20/40 (median = 20/40), with mean improvement in visual acuity of 0.80 logMAR units. Intra-operative suprachoroidal hemorrhage occurred in 1 patient (7%) and post-operatively in 2 patients (14%); all resolved spontaneously; mean post-operative VA in these three patients was 20/40. There were no cases of intra-operative or post-operative choroidal detachment. Post-operatively, 5 (36%) developed cystoid macular edema; 3 (24%) had vitreous hemorrhage; 2 (14%) had hyphema; 2 (14%) developed epiretinal membrane; 2 (14%) had corneal decompensation, including one with perforation of penetrating keratoplasty graft requiring enucleation and the other with light perception vision after a detached DSAEK graft; 1 (7%) had ACIOL instability, corrected on the first post-operative day; 1 (7%) had iris capture of the ACIOL necessitating IOL exchange; 4 (28%) had no complications. There were no cases of post-operative glaucoma, uveitis-glaucoma-hyphema syndrome, or retinal detachment. Mean follow-up was 62 weeks (median = 13.5 weeks).
Transpupillary PCIOL removal with PPV and placement of ACIOL is in an effective procedure for improvement in VA, requiring proper management of post-operative complications. The most common post-operative complications were found to be cystoid macular edema and vitreous hemorrhage. The most detrimental complication in this series was corneal decompensation, resulting in very poor visual outcomes.
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