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Kenneth M Yee, Christianne A Wa, Justin H Nguyen, H. Stevie Tan, Sarit Yael Lesnik-Oberstein, Benjamen A Filas, Ying-Bo Shui, David C Beebe, Alfredo A Sadun, J Sebag; Reducing post-vitrectomy cataracts. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2205.
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Cataracts are known to develop after vitrectomy (PPV), a process believed to be due to increased retrolental oxygen levels. The finite element oxygen model of cataractogenesis proposed by Filas et al [IOVS 2013;54:6549-59] predicts that an eye with intact anterior vitreous and without posterior vitreous detachment (PVD) will have 50% lower retrolental oxygen levels, thereby mitigating cataracts. Thus, cataract formation after vitrectomy might be curbed by performing vitrectomy without removing anterior vitreous and not inducing PVD intra-operatively. This hypothesis was tested in a retrospective study of patients undergoing minimally-invasive vitrectomy for floaters.
59 phakic eyes in 48 patients (26 males, 22 females; 58 ± 15 years old; range = 24 - 81 years) underwent minimally-invasive 25 gauge vitrectomy for floaters. PVD was not induced intra-operatively and 3-4 mm of anterior vitreous was left intact behind the lens. The results were compared to 23 eyes in 18 patients (63 ± 8 years old; range = 44 - 75 years) undergoing vitrectomy for floaters that included surgical induction of PVD and extensive vitreous removal.
In the minimally-invasive group without PVD induction, 13/59 (22%) eyes developed cataracts requiring surgery, on average 13.1 months post-vitrectomy (age range 56-82 years). In the extensive vitrectomy cases where PVD was induced surgically, 20/23 (87%) eyes required cataract surgery (P<0.0001) on average 7.3 months post-vitrectomy (age range = 50-75 years old), which is considerably sooner than following minimally-invasive vitrectomy (P < 0.002). FIG. 1 LEGEND: By 16 months after vitrectomy (PPV) the risk of cataract formation requiring surgery is more than 80% in patients who underwent extensive PPV with PVD induction, but just around 20% in the minimally-invasive PPV group without PVD induction.
Not inducing PVD and leaving the anterior vitreous intact during vitrectomy seems to be associated with a 4-fold lower risk of subsequent cataract surgery in the short term (P<0.001). Furthermore, it seems to take 79% longer before cataract surgery is needed after minimally-invasive vitrectomy for floaters (P<0.002). Continued surveillance will determine any long-term differences, but these results are consistent with the predictions of the finite element model of intraocular oxygen distribution, and should be further tested in a randomized prospective study.
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