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M. H. Colyer, N. Khan, D. M. Berinstein, E. D. Weichel, M. M. Lai, R. A. Garfinkel, R. J. Sanders, W. F. Deegan; Outcomes for Same Day Pars Plana Vitrectomy for Retained Lens Fragments Following Complicated Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5207.
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To evaluate the visual outcomes and adverse events in eyes with retained lens fragments undergoing same day pars plana vitrectomy (PPV) following complicated cataract surgery.
A retrospective, consecutive case series at a single institution of 123 eyes undergoing PPV with removal of retained lens fragments due to a complicated cataract extraction between 2005 and 2008. Visual acuity outcomes of 47 eyes were excluded due to pre-existing ocular disease or lack of documented visual acuity at three months. The data recorded included patient age, gender, pre-operative visual acuity prior to cataract extraction, post-operative vision after PPV, type of implanted intraocular lens, vitrectomy instrumentation and gauge size, and intraoperative & postoperative adverse events. Two surgical groups for pars plana lensectomy were defined as "immediate" if surgery was performed within 24 hours and "delayed" if surgery was performed after 24 hours. All Snellen visual acuities were converted to logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) for statistical and comparative analysis.
The median age was 75 +/- 11 years (range, 45-98). The median time to vitrectomy for the delayed group was 8 +/- 3 days (range, 1-120). The preoperative logMAR BCVA for immediate vitrectomy was 0.59 +/- 0.12 versus 0.78 +/- 0.15 for delayed vitrectomy (p=0.34). The three month logMAR acuity was 0.17 +/- 0.04 for immediate vitrectomy compared to 0.18 +/- 0.03 for delayed vitrectomy (p=0.80). Of 41 eyes undergoing immediate vitrectomy, eight (19%) experienced postoperative complications while 21 of 80 eyes (26%), experienced complications if undergoing delayed vitrectomy (Fisher’s exact, p=0.50). Overall, the most common complication was cystoid macular edema (CME) occurring in 20 of 123 eyes (16%).
The outcomes of immediate PPV appear to be similar to delayed PPV with no significant differences with respect to visual acuity or adverse events. The risks and benefits related to the timing of vitrectomy following a complicated cataract surgery should be carefully discussed with each patient. Further investigation is warranted in order to establish an optimal time for surgical planning.
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