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P. Mruthyunjaya, M. Cusick, J. P. Ehlers, E. A. Postel; Outcomes of Early versus Delayed Vitreoretinal Surgery for Retained Lens Fragments Following Complicated Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2558.
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To evaluate outcomes, complications, and the effect of timing of pars plana vitrectomy (PPV) for retained lens fragments (RLFs) after complicated cataract surgery.
Retrospective review of 73 consecutive patients referred to Duke Eye Center who had posterior capsule rupture and RLFs after cataract surgery from 1997 to 2008. The general surgical approach (6 surgeons) was a 20 gauge 3-port pars plana vitrectomy (PPV), using the vitreous cutter and/or fragmatome for lens fragment removal. Follow-up data was collected at standard intervals. Outcomes were analyzed in two ways based upon the timing of surgery: (1) same-day vs. delayed PPV and (2) 0-7 days vs. 8-30 days vs. 31+ days. Statistical testing includes Student t-test to compare means, and Fisher’s exact test to compare proportions.
Of the 73 patients, 52 (71%) had delayed PPV (range, 1-327 days). Of those presenting for delayed PPV, 2 patients (4%) presented with endophthalmitis, 1 (2%) with retinal detachment, 34 (65%) with vision 20/40, 6 (35%) had a final vision of 20/40, 9 (26%) had a final vision 20/40 (p=1.0), vision<20/400 (p=0.5), or post PPV complications of retinal detachment or glaucoma. In analysis 2, patients who underwent PPV within 0-7 days had better final visual acuity than those patients who underwent PPV at 8-30 days (0.54 vs 1.05, p=0.04). No other significant differences were found among these interval groups in outcomes or complications
PPV performed on the same day as cataract surgery did not influence visual outcomes or complications compared to delayed PPV. PPV performed within 7 days may result in a better final visual acuity compared to later PPV. PPV on the same day as cataract surgery does eliminate the need for a second operation and may hasten visual recovery. Patients referred to the retina specialist with RLFs may present with significant morbidity including endophthalmitis, retinal detachment, corneal edema, and elevated intraocular pressure.
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