Abstract
Purpose:
To compare visual acuity (VA) outcomes and adverse events in patients with retained lens fragments (RLFs) undergoing same-day versus delayed pars plana vitrectomy (within one week and greater than one week).
Methods:
Retrospective, consecutive case series over a 22-year period (1990-2011) at a university referral center.
Results:
The study included 569 eyes of 568 patients, with a median age of 74 years and a median follow up of 8 months (1 week - 100 months). Excluded from the analysis were 21 patients who did not have follow-up VA recorded. 117 eyes (21%) received same-day vitrectomy, 131 eyes (23%) received PPV within one week and 321 eyes (56%) received delayed PPV. Median time to vitrectomy in the same-week group was 5 days compared to 22 days in the delayed group. At 3 months, 6 months, and at last examination after vitrectomy, there were no statistically significant differences in VA outcomes between groups (P≥0.095). At the last examination, 61%, 63%, and 59% of patients receiving same-day, within one week, and greater than one week PPV respectively achieved VA ≥ 20/40 (P=0.35) and 16%, 15%, and 21% had VA ≤ 20/200 (P=0.29). There were no differences between groups when assessing cystoid macular edema (P=0.96), retinal detachment (P=0.096), intraocular pressure > 30mmHg (P=0.88), vitreous hemorrhage (P=0.57), or suprachoroidal hemorrhage (P=0.26). The most common cause of reduced VA (≤ 20/40) was cystoid macular edema (20%), followed by retinal detachment (13%), preexisting ocular disease (11%), macular degeneration (10%), and corneal edema (10 %). When excluding patients with pre-existing disease (N=115) (advanced age-related macular degeneration, prior retinal detachment, and advanced glaucoma) there was no significant differences in visual acuity and complication rates between the three groups.
Conclusions:
In the current study, patients undergoing same-day versus PPV within one week versus vitrectomy greater than one week for retained lens fragments have similar outcomes and complication rates. Hence, same-day surgery, while logistically attractive, was not associated with better outcomes.
Keywords: 762 vitreoretinal surgery •
688 retina •
445 cataract