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Chaerin Park, Se Joon Woo, Joon Young Hyon, Tae Woo Kim, Kyu Hyung Park; Management Of Vitreal Loss From Posterior Capsular Rupture During Cataract Operation: Posterior Versus Anterior Vitrectomy?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6688.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the efficacy between 23-gauge sutureless pars plana vitrectomy (PPV) and anterior vitrectomy in the management of vitreous loss associated with posterior capsular rupture (PCR) during cataract surgery.
Medical records of 195 eyes which sustained PCR during cataract surgery between January 2006 and July 2011 were retrospectively reviewed. Forty two eyes in which PCR was not accompanied by vitreous loss so that vitrectomy was unnecessary and 14 eyes with follow-up period less than 1 month were excluded. Thirty two eyes which underwent 23-gauge sutureless pars plana vitrectomy (group PPV) and 107 eyes which underwent anterior vitrectomy (group AntV) were compared in postoperative visual outcomes, postoperative intraocular pressure (IOP) and postoperative complications.
The mean follow-up period was 9.8 ± 10.9 months (range: 1-43 months) in the group PPV and 13.4 ± 14.3 months (range: 1-58 months) in the group AntV (p=0.190). The final best-corrected visual acuity was 20/40 or better in 90.6% (29 eyes out of 32 eyes) of group PPV and 80.4% (86 eyes out of 107 eyes) of group AntV (Fisher’s exact test, p=0.139). The rate of 20/40 or better of uncorrected visual acuity on the first postoperative day, the postoperative 7th day and the postoperative 30th day were 44.0%, 58.6%, 78.1% in the group PPV and 22.0%, 32.2%, 51.9% in the group AntV respectively (Fisher’s exact test, p=0.040, 0.016, and 0.013). 6.3% in the group PPV and 52.3% in the group AntV have used IOP-lowering drug more than once postoperatively, and eyes which showed abnormal IOP on the 1st postoperative day were only one eye out of 32 eyes (3.7%) in the group PPV and 17 eyes out of 107 eyes (25.8%) in the group AntV (Fisher’s exact test, p=0.000 and 0.019). In the group AntV, postoperative endophthalmitis and retinal detachment affected 1 eye (0.9%) each, neovascular glaucoma and pseudophakic cystoids macular edema (CME) occurred in 3 eyes (2.8%) and 5 eyes (4.7%) respectively, IOL instability was developed in 5 eyes (4.7%), and vitreous prolapse in anterior chamber was detected in 20 eyes (18.7%), while no significant postoperative complications occurred in the group PPV.
23-gauge sutureless PPV is a safe and reliable solution for managing vitreous loss during cataract surgery. It enables rapid recovery of visual acuity and less postoperative complications. It is expected to be considered primarily as management of vitreous loss during cataract surgery in institutes with vitreoretinal surgeon.
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