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Steven J. Ryder, Anton Orlin, George J Parlitsis, Ya-Lin Chiu, Donald J D'Amico, Robison Vernon Paul Chan, Szilard Kiss; A Comparison of Same-Setting versus Delayed Vitrectomy in the Management of Retained Lens Fragments Following Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2343.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal retained lens fragments (RLF) are a rare but potentially serious complication of phacoemulsification. The purpose of our study is to compare same setting ("no wait") vitrectomy to delayed surgery in the management of RLF in as single academic setting.
Retrospective, non randomized study of all patients undergoing pars plana vitrectomy (PPV) for RLF following cataract surgery from 2007-2012. Outcomes included visual acuity and the development of various complications such as retinal detachment, elevated intraocular pressure (IOP) >30 mm Hg and cystoid macular edema. Multivariate analysis was performed to adjust for potentially confounding variables such as age and preoperative visual acuity.
28 consecutive eyes (13 same setting, 15 delayed setting) were included in the analysis. Patients in the same setting group were older than in the delayed one (81.00 vs 72.87 yrs, p=0.053). No other preoperative differences existed between groups (axial length, preoperative vision, IOP). Mean time to PPV in the delayed group was 26.6 days (range 1-91 days). Mean follow up time was 363 days (same setting) and 643 days (delayed). At most recent follow up, no significant difference existed in mean vision between the same setting (logMAR 0.42) and delayed group (logMAR 0.57), p=0.132. Multivariate analysis showed no difference in final vision when adjusting for age and preoperative vision. Although there was a trend for eyes in the same setting group to obtain good vision (>/= 20/40) faster, a higher percentage of eyes in the delayed group obtained good vision at most recent follow up (66.7% vs 23.1%, p=0.02). More eyes in the delayed group had an IOP>30 at any point (p=0.055). There was no significant difference between groups in any other complications such as retinal detachment, choroidal detachment, and CME during follow up.
In our cohort, same setting PPV offers no significant visual acuity advantage over delayed PPV in patients with retained lens fragments. Fewer eyes in the same setting group "ever" had an intraocular pressure >/= 30 during follow up, while no other complication differences were seen between groups.
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