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Gelareh Abedi, Timothy Cleland, Lina Marouf; Management of Retained Lens Fragments After Phacoemulsification: Comparing Visual Outcomes of Early Pars Plana Lensectomy versus Late Pars Plana Lensectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6667.
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© ARVO (1962-2015); The Authors (2016-present)
To compare visual outcomes of patients with retained lens material after phacoemulsification who had early versus late pars plana lensectomy
A retrospective chart review of patients referred to a single private retina practice in San Antonio, Texas between January 2007 and December 2010. Patients were divided into two groups. An Early Vitrectomy Group (group one) underwent pars plana vitrectomy (PPL) within the first 14 days of cataract surgery while the Late Vitrectomy Group (group two) had PPL performed greater than two weeks following cataract surgery. Demographic information, pre-and postoperative visual acuity, and complications were collected for 6 months after PPL surgery. Two-tailed t-test with 95% confidence interval was used to calculate significant difference between the two groups.
A total of 26 patients meeting the inclusion criteria with retained lens fragments requiring pars plana lensectomy (PPL) were identified in the 3-year period from 2007 to 2010 with 15 patients in group one and 11 patients in group two. The average age was 72 (group one) and 74 (group two) with a female to male ratio of 2:1. Fifty percent of the patients in each group had diabetes. None of the patients had clinically significant macular edema (CSME) or age related macular degeneration prior to cataract surgery. In group one, the average retina referral time was 3 days and the average time between cataract surgery and retina surgery was also 3 days. In group two, the average retina referral time was 96 days. The average PPL from referral date was 9 days. About 20% of patients at the time of retina referral were aphakic in both groups. The preoperative logMAR visual acuity (Va) prior to PPL in group one was 1.49 and in group two was 0.94. The postoperative logMAR Va at week one, month one, and month 6 were analyzed. Although there was no significant difference in visual acuity outcome between the two groups, there was a trend toward significance at week one (1.14 vs. 0.6; p-value: 0.07) with group two having a slightly better visual acuity at week one. Postoperative visual acuity at 6 months was 0.81 (group one) and 0.67 (group two). One patient in group one developed retinal detachment and there was a higher number of patients developing cystoid macular edema in group two.
There was no significant difference in patients’ final visual acuity between early and late pars plana lensenctomy (PPL) for retained lens material. However there was a trend toward a higher rate of cystoid macular edema (CME) in patients with retained lens material in group two. A subgroup analysis of the CME cases in group two revealed that 75% had diabetes.
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