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S. D. Mitchell, T. J. Federici, J. H. Tsai; Significance of Anterior Vitreous Pigment after Cataract Extraction. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3171.
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Pigment cells in the anterior vitreous, also known as Schafer's sign, is a clinical finding that is strongly predictive of retinal tears and/or retinal detachment in phakic eye. It is unknown how cataract surgery affects the release of pigment into the anterior vitreous. The purpose of this study is to assess the incidence and significance of anterior vitreous pigment after cataract surgery.
Patients were recruited if they qualified for cataract surgery and had no history of previous retinal detachment, retinal laser, or pseudoexfoliation in the qualifying eye. Complete ophthalmic examination was completed prior to cataract surgery. Patients reviewed IRB approval and electively consented to participate in the study. Three dilated fundus examinations were completed during the post-operative period approximately day 1, 8, and 38 to assess the anterior vitreous for pigment granules. Visual acuity, iris color, and anterior chamber reaction were also noted. If vitreous pigment was seen, a scleral depressed examination was performed in search for retinal tear or detachment.
Twenty-three patients were enrolled in the study and two were unable to complete the post-operative dilated examinations and were not included in the results. No anterior vitreous pigment was identified on pre-operative examinations and 7 patients had posterior vitreous detachments in the study eye. All surgeries were performed by one surgeon and were uncomplicated without posterior capsular tear. Of the 21 patients completing the study, average age was 64.2 (range 48 to 74), 57.1% were male, and 95.1% were Caucasian. Average axial length was 25.1 (range 22.38 to 29.58) with an average 16.0 (range 6.0 to 23.0) diopter lens inserted. Anterior vitreous pigment was observed in one patient on post-operative day #7. He had 2-3+ anterior chamber inflammation with mainly pigmented cells and no evidence of retinal tear or detachment on scleral depressed exam. On the next post-operative visit, day #28, the patient had rare anterior chamber cells and the pigmented cells in the anterior vitreous had resolved. No retinal tear or detachment occurred and it is hypothesized that these vitreous pigment granules were secondary to the anterior chamber reaction. The remaining 20 patients did not have anterior vitreous pigment during the entire post-operative course.
After modern day cataract surgery, anterior vitreous pigment has been identified in association with significant anterior chamber inflammation and in the absence of retinal tear or detachment. In the absence of significant anterior chamber inflammation, Schafer's sign may still be indicative of retinal tear or detachment after cataract surgery.
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