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Rachel Song, Steven Ness; Refractive outcomes following pars plana vitrectomy/pars plana lensectomy (PPV/PPL) for retained lens fragments due to complicated cataract surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2989. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To study differences in refractive outcomes following PPV/PPL for retained lens fragments due to complicated cataract surgery based on timing as well as type of intraocular lens (IOL) placed.
A retrospective chart review of 16 eyes was performed. All subjects had at least 6 months of post-surgical follow-up. Predicted refractive outcome (based on preoperative ophthalmic biometry) was compared to the spherical equivalent (SE) of actual post-operative refractive outcome. Actual refractive outcome was based on manifest refraction in subjects with vision better than 20/200 and on autorefraction in subjects with vision 20/200 or worse. Variables studied included the type of IOL placed as well as the timing of lens placement (either at the time of initial cataract surgery or at the time of PPV.)
Sixteen eyes were included. 7 of 16 eyes (44%) had an IOL placed during cataract extraction (CE), of which 4 of 7 (57%) had a sulcus intraocular lens (SIOL). Thirty three percent (3 of 9) eyes with IOL placement during PPV/PPL received SIOL.<br /> In eyes implanted with an IOL at the time of CE, average actual refractive error was 0.21D more myopic than predicted, as compared to 0.74D more myopic in those eyes implanted with an IOL at the time of PPV/PPL. Among eyes with lens placement at the time of PE, SIOL placement resulted in an average SE difference of -0.64D, while ACIOL placement had an average SE difference of +0.36D. Among eyes with IOL placement at the time of PPV/PPL, SIOL placement resulted in average SE difference of -0.72D, as compared to -0.74D for ACIOL placement.
While this study is limited by a small sample size, initial data indicates that IOL placement at the time of PPV/PPL in cases of retained lens fragment may result in a more myopic postoperative refractive error than expected, and that ACIOL placement at the time of CE may result in an undesirable postoperative hyperopic refraction. Surgeons should consider this data when considering strength of lens to implant.
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