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J Guerrero, R Pinto, W Feuer, WE Smiddy; Avoiding Retinal Detachment After Vitrectomy for Retained Lens Fragments . Invest. Ophthalmol. Vis. Sci. 2002;43(13):645.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To determine if precautions taken during surgical repair of retained lens fragments can be effective in avoiding postoperative retinal detachment. Methods:Retrospective review of 102 cases of eyes undergoing vitrectomy for retained lens fragments(RFL) after cataract extraction managed by one surgeon. Preoperative data collected included age,gender,eye,visual acuity(VA),lens status,presence of corneal edema or retinal detachment,and intraocular pressure.Intraoperative data included presence of retinal break and methods of management of retinal detachment.Postoperative data included the incidence of a retinal detachment and its methods of management,best and final VA,reason for decreased VA, and duration of followup examination.Precautions taken to minimize the occurrence of postoperative retinal detachment included: brief delay in vitrectomy to allow decrease inflammation,completing removal of vitreous before procceding to lens fragmentation,fragmentation using low power settings,inspection of the retinal periphery at the conclusion of surgery,and strategically timed postoperative evaluations. Results:There were 51 females and 51 males with an average age of 76.2.The interval from cataract extraction to vitrectomy was within one month in 87% and averaged 22.1 days.The final VA was at least 20/40 in 51%.The mean follow-up interval was 11.0months.The incidence of retinal detachment at presentation was 4%.postoperatively there were 4% with new retinal detachments;one presented 6 months later,while the other 3 ocurred 1 week to 10 weeks after vitrectomy.Two were managed with fluid-air exchange and laser and two underwent further vitreous surgery with placement of a scleral buckle. The retina was reattached in all cases;the best postoperative VA was 20/400 or better in all cases. Retinal breaks were noted and treated during the initial vitrectomy in 7eyes;5 did not develop a retinal detachment,but 2 did. Conclusion:The previously reported incidences of postoperative retinal detachment(as high as 10%)may reduced with certain precautions in surgical technique and perioperative management,which also may enhance the prognosis if retinal detachment still intervenes.
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