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Balaji Perumal, Asheesh Tewari; Long Term Visual Outcomes with Small-Gauge Vitrectomy Surgery for Retained Lens Fragments. Invest. Ophthalmol. Vis. Sci. 2011;52(14):530.
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To evaluate long term visual outcomes and explore etiologies for delayed visual recovery in patients treated with 23-gauge vitrectomy surgery for retained lens fragments after cataract surgery.
25 consecutive cases of 23-gauge vitrectomy for retained lens fragments were reviewed. The DORC (Dutch Ophthalmic Research Center) 23-gauge wound entry system was used with the Alcon 23-gauge vitrector for all surgeries. Data reviewed in this extension study included pre-operative visual acuity, best corrected visual acuity at most recent follow-up, complications, eye co-morbidities, and macular optical coherence tomography (OCT) scans.
There were 14 males and 11 females included in the study. Mean age was 71 years (48 - 90 years) and mean follow-up was 11.4 months (1.5 - 29.2 months). Mean visual acuity prior to vitrectomy was 20/468 (20/25 - Hand Motion) and mean visual acuity improved to 20/52 (20/20 - Count Fingers at 10 feet) at most recent follow-up (p < 0.00001). Twenty-four eyes (96%) had visual improvement and 20 eyes (80%) gained 3 or more lines of vision. Six eyes (24%) developed cystoid macular edema (CME) post-surgically which was persistent for at least 2 months. One eye (4%) developed localized retinal detachment. In addition, decreased vision in 2 eyes was attributed to advanced glaucoma and geographic atrophy.
Long-term outcomes demonstrate a trend towards improved visual acuity with small gauge surgery for retained lens fragments. In this case series, delay in visual recovery was most often due to CME. Further study will be focused on treatment strategies for post-vitrectomy cystoid macular edema, including topical non-steroidal anti-inflammatory agents and periocular steroids.
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