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Y.–S. Hwang, J.L. Davis; Cataract Extraction Combined With Pars Plana Vitrectomy in Uveitis Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):629.
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© ARVO (1962-2015); The Authors (2016-present)
To report preoperative characteristics, visual outcomes and complications of pars plana vitrectomy performed concomitantly with either phacoemulsification and intraocular lens insertion (PhacoPPV+IL) or pars plana lensectomy (PPL) for uveitic cataract.
The medical records for patients treated with PhacoPPV+IL and PPL for cataract in uveitis patients at a single institution between January 1, 1992, and December 31, 2001, were reviewed.
80 eyes of 63 patients and 38 eyes of 28 patients received PhacoPPV+IL and PPL respectively. The mean age of patients was 51±16.9 years for PhacoPPV+IL group and 23±20.6 years for the PPL group (p<.001). The mean interval from uveitis diagnosis to cataract surgery was 7.1±7.05 years for PhacoPPV+IL and 4.4±4.71 years for PPL (p=.025). Anatomic uveitic diagnoses did not differ significantly between groups. The preoperative mean corrected visual acuity was 20/125 and 20/640 for PhacoPPV+IL and PPL groups respectively (p<.001). Posterior synechiae were present in 56.3% and 97.4% of eyes respectively (p<.001). For the PhacoPPV+IL group, postoperative complications included capsular opacity (46.5%), cystoid macular edema (18.6%) and posterior synechiae (11.6%). For the PPL group, complications included transient or persistent hypotony (55.1%), glaucoma (13.8%), vitreous hemorrhage (10.3%) and retinal detachment (10.3%). Uveitis was controlled postoperatively in 93% and 84% of patients respectively. The final mean visual acuity was 20/40 and 20/63 (p<.001) and the logMAR change between preoperative and postoperative visual acuity was 0.64±0.07 and 1.46±0.23 in the two groups (p=.03) with 51 eyes (63.8%) and 16 eyes (42.1%) achieving 20/40 or better visual acuity (p=.007). Percentage use of immunomodulatory drugs postoperatively was 18.5% and 17.5%.
PhacoPPV+IL was more likely to be selected as the means of cataract extraction with PPV in older patients who had longer duration of uveitis, better vision, and less posterior synechiae formation. Frequency of postoperative complications did not differ whether PhacoPPV+IL or PPL was performed, but type of complication did, with transient or persistent hypotony much more common in the PPL group. Postoperative uveitis control was similar between surgical procedures. Final vision was correlated with the preoperative visual acuity, but not with the surgical procedure. PPV combined with either Phaco+IL or PPL was associated with visual improvement and manageable complications in most patients.
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