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M. H. Colyer, D. M. Berinstein, J. M. Minarcik, N. J. Khan, M. M. Lai, R. C. Katira, W. B. Phillips, R. A. Garfinkel, R. J. Sanders; Outcomes of Micro-Incisional Vitrectomy Compared to 20-Gauge Vitrectomy for Retained Lens Fragments Following Complicated Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2559.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcomes and adverse events of eyes with retained lens fragments undergoing small-gauge pars plana vitrectomy (PPV) as compared to standard PPV.
A retrospective, consecutive case series at a single institution of 205 eyes undergoing PPV with removal of retained lens fragments due to a complicated cataract extraction between 2005 and 2008 with at least three months of follow-up. Two surgical groups were defined depending on the gauge of instrumentation. Group 1 included 79 eyes of patients undergoing standard 20-gauge three-port PPV. Group 2 included 126 eyes of patients undergoing micro-incisional PPV (25 gauge-41 eyes, 23 gauge-85 eyes). All Snellen visual acuities were converted to logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) for statistical and comparative analysis.
The mean age was 75 ± 2.4 years (range, 25-95). The mean preoperative vision of Group 1 was 0.82 ± 0.18, while the mean preoperative vision of Group 2 was 0.79 ± 0.13 (p=084). Mean time to surgery was 10 ± 3 days. Phacofragmentation was utilized in 67 of 85 eyes (79%) in Group 1 and 84 of 126 eyes (67%) in Group 2. Final logMAR acuity was 0.47 ± 0.15 for Group 1 compared to 0.47 ± 0.12 for Group 2 (p=0.98). In Group 1, 27 (34%) eyes developed postoperative complications while 35 of 126 eyes (28%) developed complications in Group 2 (p=0.70). Overall, the most common complication was cystoid macular edema (CME) occurring in 27 of 205 eyes (13%). Only one eye developed hypotony in Group 1, while three eyes in the Group 2 developed hypotony. Two patients in Group 2 developed culture positive endophthalmitis.
The outcomes of small gauge PPV appear to be similar to standard PPV with no statistically significant differences with respect to visual acuity or adverse events. When considering surgical approaches to patients with retained lens fragments, micro-incisional vitrectomy is a safe and practical procedure.
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