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A. Y. Hu, R. E. Coffee, A. Gupta, S. D. Schwartz; Cataract Progression After 25 Gauge Vitrectomy: 2 Year Results. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5993.
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Since the introduction of the 25-gauge vitrectomy in 2002, there has been widespread use of the technique. Our group has reported low rate of cataract progression (28%) and cataract extraction (11%) one year after 25-gauge vitrectomy surgeries. The purpose of this study is to evaluate the rate of postoperative cataract progression as well as the incidence of cataract extraction surgery for 2 years following 25-gauge transconjunctival vitectomy surgery.
A retrospective study of 116 consecutive phakic eyes that underwent 25-gauge transconjunctival vitrectomy was carried out. The follow up period was until time of cataract surgery or until 2 years status post vitrectomy surgery, whichever occurred first. The severity of nuclear, cortical, and posterior subcapsular lens opacities was graded during slit lamp examination using the Lens Opacities Classification System II. The main outcome was cataract progression defined as any change in lens opacification. The secondary outcome measure was the rate of eyes that were referred for cataract extraction.
Of the 116 phakic eyes that underwent 25-gauge vitrectomy, 49 phakic eyes were excluded from this study secondary to history of prior vitreoretinal surgeries (13), subsequent vitreoretinal surgery during the 2 years follow up period (17), or combined vitrectomy with lensectomy (19). Additional 8 phakic eyes were excluded secondary to lost to follow up (last visit less than 2 years status post 25-gauge vitrectomy surgery). This cohort was a heterogeneous population undergoing 25-gauge vitrectomy for a variety of indications, including mainly macular diagnoses. At the close of surgery, 9 eyes had intraocular gas, 31 eyes had intraocular air, and 19 eyes had fluid. Of the 59 phakic eyes, forty-eight eyes (81%) had documented postoperative cataract progression at 2 years follow up. Twenty-five phakic eyes (42%) underwent cataract extraction within 2 years follow up after 25-gauge vitrectomy.
Cataract progression following 25-gauge vitrectomy surgery seems lower than published data after conventional 20-gauge vitreoretinal surgery. The many possible explanations include shorter operative times, less complete anterior vitreous gel removal, less instrument exchange and less manipulation of anterior structures. Regardless of potential explanation, and the limitations of a retrospective, uncontrolled study, the observation that 25-gauge vitreoretinal surgery leads to lower rate of cataract progression at 2 years may be significant.
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