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M. Kirzhner, Y. Shildkrot, J. E. Puklin, R. Iezzi, D. Eliott, G. W. Abrams, T. H. Mahmoud; Intraocular Pressure Changes and Glaucoma in Patients Undergoing Pars Plana Lensectomy and Vitrectomy for Retained Lens Material after Complicated Cataract Extraction. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4167.
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To determine factors affecting intraocular pressure (IOP) and the need for glaucoma surgery in patients undergoing pars plana lensectomy and vitrectomy (PPL/V) for retained lens materials.
A retrospective chart review was conducted of patients who underwent PPL/V between 2000 and 2007. Patients with no history of cataract extraction (CE), follow-up of less than 30 days, or a recent history of severe globe trauma requiring PPL/V were excluded.
We identified 118 consecutive patients, 64 males and 54 females, who were entered into the study. Mean age at the time of PPL/V was 69.7 ± 12 years (range 21 to 92 years) with a mean follow-up of 523 ± 512 days (range 32 to 2611 days). IOP increased following cataract extraction by a mean of 13.4 mmHg from a mean of 17.3 to a mean maximum IOP (Tmax) of 30.7 mm Hg (2-tailed t-test, p<0.0001), which then improved following PPL/V to a mean Tmax of 24.4 (2-tailed t-test, p < 0.0001). IOP continued to improve and by the last visit, the mean IOP was similar to pre-cataract extraction pressure (2-tailed t-test, p > 0.76). Pre-existing diagnosis of glaucoma or glaucoma suspect was associated with a higher mean Tmax following PPL/V (27.5 ± 1 vs. 22.6 ± 1, ANOVA, p = 0.0078), need for glaucoma surgery (6/44, 13.6% vs. 1/74, 1.35%, Pearson, p = 0.0063), and longer duration of glaucoma drops use (222 ± 49 vs. 58 ± 39 days, ANOVA, p = 0.0102). While pre-cataract extraction IOP was higher in patients with established or suspected glaucoma (ANOVA, p = 0.0048), at the end of the follow-up, IOP was similar in the two groups (ANOVA, p > 0.7). The final visual acuity was not affected by pre-existing history of glaucoma or glaucoma suspect.
PPL/V for retained lens material is associated with better control of IOP. Pre-existing glaucoma or a diagnosis of glaucoma suspect may predispose to a more difficult control of IOP following PPL/V and an increased need for glaucoma surgery.
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