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A Tewari, D Eliott, SL Perkins, AC Holtebeck, W Wirostko, T Connor Jr; Visual Outcomes and Progression of Diabetic Retinopathy in Cataract Extraction Complicated by Retained Lens Fragments . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3472.
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Purpose: To determine visual outcomes and retinopathy progression in diabetics undergoing vitrectomy for retained lens fragments (RLF) after cataract extraction. Methods:Retrospective review of 33 patients with diabetes mellitus who underwent pars plana vitrectomy for RLF in one eye only between 1993 and 2001 with a minimum follow up of 6 months. Final visual acuity and status of diabetic retinopathy for both eyes were recorded from the most recent clinic visit. Our primary outcome measures were asymmetric progression of retinopathy and final visual acuity greater than or equal to 20/40. In cases of unilateral progression, comparison to the degree of progression in the fellow eye was performed. In such cases, significant progression attributable to the RLF was considered to occur when the affected surgical eye showed greater progression than the nonaffected fellow eye. Results: Follow up ranged from 6 to 101 months, with a median of 24 months. No patient had active macular edema or proliferative retinopathy at the time of cataract surgery. Asymmetric retinopathy progression, in which progression was noted in only the operated eye, occurred in 7 eyes (21%) within 12 months. Nonproliferative retinopathy developed in 3 eyes where none previously existed; new macular edema developed in 3 eyes; and new proliferative retinopathy developed in 1 eye. Only 12 patients (36%) had a final visual acuity of 20/40 or better. Poor visual outcomes (20/100 or worse) were observed in 7 patients (21%). Additionally, there was an association of baseline retinopathy level with the rate of progression: patients with preexisting nonproliferative diabetic retinopathy were 18 times more likely to progress when compared to other patients (p= 0.02). Conclusion:RLF in diabetics can be associated with retinopathy progression, particularly in eyes with nonproliferative retinopathy at baseline. RLF in diabetics, with or without retinopathy progression, frequently results in compromised visual acuity.
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