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Adam Sise, Tanuj Banker, Eric Weichel; Cataract Formation After Small Gauge Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1566.
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To identify the prevalence and rate of cataract surgery after strictly small gauge retinal detachment repair (23 or 25 gauge) which has not been well established in the literature, and to evaluate long term visual outcomes after cataract extraction (CE) in vitrectomized eyes.
Retrospective case series from 2011 through 2012 by one group of retina surgeons performing primary RD repair using either 23 or 25 gauge pars plana vitrectomy (PPV) instrumentation with or without scleral buckle (SB). Exclusion criteria included preoperative proliferative vitreoretinopathy, postoperative retinal re-detachment, pre-existing macular disease, previous PPV or SB, documented follow-up of less than 3 months, and patients with prior CE. Main outcome measures included rate and time of CE following PPV. Secondary outcome measures included degree of visual improvement following CE, and evaluation of risk factors such as age and use of SB.
A total of 86 patients were identified, mean age 56 years ±9.98, followed for a mean of 470 days ±263. 47 eyes underwent CE during the follow-up period. There was no significant difference in age between those who did or did not receive CE (p=0.11). Mean time to CE was 278 days ±144 with no significant difference between those eyes that had macula-on or macula-off detachments (p=0.52). The final LogMAR visual acuity (BCVA) was 0.215 ±0.343 (20/30) for eyes that underwent CE, and 0.429 ±0.386 (20/50) for those that did not undergo CE (p=0.01). Further analysis into mac-on vs mac-off detachments revealed a significant improvement in final acuity for those with mac-off detachments who underwent subsequent CE (p=0.03), while those with mac-on detachments did not reach significance (p=0.15). There was no significant relationship between those patients who received a SB at the time of PPV and underwent CE (p=0.22). Total follow-up time was significantly longer for those patients that ultimately received CE (mean 587 days ±211 vs 352 days ±261, p<0.0001).
Development of visually significant cataracts after small gauge vitrectomy for retinal detachment repair remains a common occurrence despite newer small gauge techniques. These cataracts can significantly decrease vision even in eyes with macula-off detachments. While most patients undergo CE within one year, long term follow-up for cataract formation is essential. Patient age and the use of SB does not affect the risk of cataract formation following PPV.
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