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Y. Shildkrot, M. Kirzhner, J. E. Puklin, R. Iezzi, D. Eliott, G. W. Abrams, T. H. Mahmoud; Factors Affecting Visual Outcomes in Patients Undergoing Pars Plana Lensectomy and Vitrectomy for Retained Lens Material After Complicated Cataract Extraction. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5996. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine factors affecting ultimate visual outcomes in patients undergoing pars plana lensectomy and vitrectomy (PPL/V) for retained lens material.
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 leading to the need for PPL/V were excluded from the study.
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). Mean baseline logMAR visual acuity (VA) of 0.94 ± 0.68 (20/174) prior to CE decreased to 1.49 ± 0.84 (20/618) after CE (2-tailed t-test, p <0.0001). Following PPL/V, VA improved significantly from baseline to 0.70 ± 0.79 (20/100, p < 0.0001). Factors correlating with worse visual acuity, as revealed by a multivariate square regression analysis, included a history of diabetes ( VA 1.04 (20/219) vs. 0.57 (20/74), p < 0.0002), worse post-cataract visual acuity (p < 0.0037), total number of additional surgeries following PPL/V (p < 0.0001), including glaucoma surgery (p = 0.0067), number of steroids used at the time of PPL/V, excluding subconjunctival dexamethasone (p = 0.005) and the use of non-steroidal anti-inflammatory medications (NSAIDs) (p = 0.045).
PPL/V resulted in a significant improvement of final VA compared to baseline VA prior to CE. History of diabetes and worse post-CE VA increased the risk of worse final visual acuity. The use of topical NSAIDs and increased number of steroids used at the time of PPL/V appeared to predict worse final visual acuity, possibly due to an increased use in complicated cases.
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