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Chi-Chin Sun, Hsi-Fu Chen, Ling Yeung; Persistent Corneal Epithelial Defect After Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):887.
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To investigate the incidence, risk factors and clinical course of persistent corneal epithelial defects (PCED) after pars plana vitrectomy.
This study reviewed retrospectively 426 consecutive patients (511 eyes) underwent PPV between January 1, 2008 and December 31, 2011 at Chang Gung Memorial Hospital, Keelung, Taiwan. All patients underwent PPV with handheld contact lens viewing system. Exclusion criteria were: 1. Patients with corneal edema or epithelial disturbance before vitrectomy; 2. Surgical indications of infectious endophthalmitis, globe rupture and ocular perforation or penetrating injury with or without intraocular foreign body. Eyes of corneal complications (103 eyes) were identified as presence of corneal epithelial defects (ED), corneal edema or superficial punctate keratopathy (SPK) at least one week after vitrectomy. Twenty-one eyes developed PCED for corneal ED persisting more than 2 weeks despite conventional treatments. The demographic, preoperative, intra-operative, and postoperative data were compared between PCED and non-PCED corneal complication groups to investigate the risk factors.
Post-op corneal complications developed in 56 of 248 (22.6%) diabetic eyes. The diabetics predisposed to post-op corneal ED (P=0.021), and SPK (P=0.022), but not to corneal edema (P=0.925). The eyes with PCED in this study had poor final visual acuity, with 23.8% of eyes (5/21 eyes) in PCED group having visual acuity of 20/200 or better as compared with 51.2% of eyes (42/82 eyes) in non-PCED corneal complication group (P=0.024). Logistic regression analysis demonstrated that diabetes mellitus (P=0.024), use of C3F8 (P<0.001), and first-year-resident assistant (P=0.032) were the statistically significant risk factors for PCED after PPV. When taking nonphakic eyes (41 eyes) into consideration, intravitreal C3F8 tamponade was significantly (P=0.001) associated with PCED (60%, 6/10 eyes) compared with non-PCED corneal complications (6.5%, 2/31 eyes).
The overall incidence of PCED after PPV was 4.8% in our study. Diabetes mellitus, intravitreal tamponade with C3F8, and first-year-resident assistant of handheld viewing lens are risk factors for PCED after PPV. PCED after PPV was correlated with poor postoperative visual outcomes. Early and aggressive management is necessary for patients presenting corneal epithelial defects after vitrectomy in order to prevent miserable complications.
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