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L. Y. Ho, M. K. Walsh, T. S. Hassan; Consecutive Case Series Using 25-Gauge Vitrectomy for Retained Lens Material. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4205.
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20-Gauge pars plana vitrectomy and phacofragmotome lensectomy have been shown to effectively remove retained lens material and restore vision following complicated cataract surgery. We describe our experience for this indication using 25-gauge vitrectomy alone (without ultrasound fragmentation) as the feasibility, efficacy, outcomes, and complications of this approach have yet to be established.
A retrospective consecutive case series was performed on the first 18 patients who underwent 25-gauge pars plana vitrectomy for retained lens material between December 1, 2005 and October 1, 2008 by a single surgeon. The following data were recorded for each patient: demographic information, preexisting eye diseases, details of the initial/final retinal examinations, vitrectomy surgery details, and complications. Eyes with preexisting disease that could limit final post-operative vision were excluded. Summary statistics and a one tailed t-test were used for data analysis.
Fourteen patients were included having an average age of 72 years, a female to male ratio of 9:5, and a mean follow up of 3 months. Eleven out of 14 patients (78.6%) had at least 25% of retained nuclear material and all 14 patients had retained cortex prior to vitrectomy. All eyes underwent 25-gauge pars plana vitrectomy at a mean of 8 days after complicated cataract surgery. There were no cases of early postoperative hypotony. The mean LogMAR visual acuity improved from 1.28 (Snellen acuity between 20/320-20/400) at presentation to 0.25 (Snellen acuity of ~20/30-2) on final examination (p=0.0002). Mean intraocular pressure was reduced from 24.0 (S.D. 11.6) mmHg preoperatively to 17.4 (S.D. 4.4) mmHg on final examination (p=0.039). The rates of postoperative cystoid macular edema and glaucoma were 28.6% and 7.1% respectively, and no patient developed a retinal detachment.
25-Gauge pars plana vitrectomy without the use of ultrasound fragmentation is an effective alternative for the management of retained lens material after complicated cataract surgery. Outcomes and complication rates of this technique are comparable to those seen in series reporting the results of 20-gauge pars plana vitrectomy. Potential benefits of small self-sealing incisions, decreased post-operative inflammation/pain, less post-operative astigmatism, and faster recovery are suggested and discussed.
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