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A. R. Gohari, J. T. Troupe, II, R. Ratnakaram; Visual Outcome and Rate of Cataract Formation After Pars Plana Vitrectomy in Phakic Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5972.
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To study visual outcome and rate of cataract formation after pars plana vitrectomy (PPV) in phakic patients.
Retrospective review of 630 consecutive vitreoretinal cases at Malcom Randall VA Medical Center in Gainesville, Florida between January 1, 2003 and August 25, 2006 was performed after IRB approval was obtained. Exclusion criteria included prior cataract surgery, cataract surgery after retina surgery at another institution, and death between January 1, 2003 and August 25, 2006. After exclusion criteria were applied 119 phakic patients were identified who underwent PPV for a variety of retina conditions such as epiretinal membrane (ERM) (n=19), macular hole (MH) (n=16), persistent clinically significant macular edema (CSME) (n=5), rhegmatogenous retina detachment (RRD) (n=25), tractional retinal detachment (TRD) (n=18), vitreous hemorrhage (VH) (n=36). Paired t-test and chi-squared test were used for statistical analysis. The following visual acuity grouping was used: NLP = 0, LP-CF = 1, 20/400 = 2, 20/200-20/80 = 3, 20/70-20/40 = 4, and 20/30-20/20 = 5.
The average patient age in each group was comparable. The mean duration of surgery was the longest in the RRD group (103±32 minutes) and shortest in the persistent CSME group (59±11 minutes). The rate of cataract development necessitating cataract extraction within the study period was 72% total, 63% in ERM group, 75% in MH group, 80% for the persistent CSME group, 96% for RRD group, 72% for TRD group, and 58% for VH group. The mean change in vision based on the visual acuity grouping was +0.4±1.1 for ERM group, +0.3±1.0 for MH group, -0.8±1.3 for persistent CSME group, +0.2±1.9 for RRD group, +0.7±1.2 for TRD group, and +1.5±1.5 for VH group. When comparing the mean change in vision based on visual acuity grouping a statistically significant difference was noted between the ERM and VH group (p < 0.01), MH and VH group (p < 0.01), RRD and VH group (p < 0.01), TRD and VH group (p < 0.05), and CSME and TRD group (p < 0.03). The mean best corrected post operative visual acuity and the mean increase in visual acuity was highest in the VH group, 4.1±0.9 and +1.5±1.5 respectively.
Repair of RRD resulted in the highest rate of cataract formation in this study. The longer duration of surgery for RRD repair may explain the increased rate of cataract formation in this group. Surgical drainage of vitreous hemorrhage resulted in the best final visual acuity and the greatest improvement in visual acuity. All groups showed an improvement in mean visual acuity except for the group with persistent CSME.
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