Retained Lens Fragment in the New Millenium

Abstract

Abstract: : Purpose: To investigate the visual acuity outcomes, clinical features, and adverse events in patients with retained lens fragments managed by pars plana vitrectomy (PPV) at a single medical center over 15 years. Methods: A consecutive case series of all patients with retained lens fragments that underwent PPV over a 15 year period (1990–2004) were reviewed. These cases were divided into three five year groups in order to study whether postvitrectomy outcomes had changed. Cases were reviewed for visual acuity, intraocular pressure elevation, cystoid macular edema (CME) and postoperative retinal detachment. Results: The groups were divided by inclusive dates: those receiving vitrectomy between 1990 and 1994 (n = 119 or 32%); 1995–1999 (n=150 or 40%); and 2000–2004 (n=108 or 29%). Visual acuity ≥20/40 at 6 months was similar for all groups; 52%, 45%, and 53% respectively (p=0.97). Visual acuities ≤20/200 were also similar in all groups; 19%, 29%, and 18% (p=0.90). There was a trend toward a decrease in percent of cases with post–operative intraocular pressure ≥30 (p=0.069) with respective cumulative 6 month percentages 8.5%, 7.6%, and 3.4%. The number of patients using glaucoma medications (p = 0.86) with respective 6 month cumulative percentages was similar between the groups; 45.2%, 44.4%, and 45.9%. However, there was a trend toward an increase in CME over time (p=0.096) with 6 month cumulative percentages 22.7%, 27.0%, and 29.8%. There was a trend (p=0.12) for a decreased rate of post PPV retinal detachments in later time periods. The one year cumulative (Kaplan–Meier) post PPV retinal detachment rates were 6.3% (9 cases), 5.5% (9 cases), and 1.0% (1 case) respectively. Delayed onset retinal detachment (>6 months post PPV) occurred in 5 of 18 patients in the two earlier groups and none in the most recent group. Conclusions: In the most recent 15 year study, the overall visual acuity outcomes were similar in all time periods. CME and glaucoma may influence visual acuity outcomes in the postoperative period. Delayed onset retinal detachment (>6 months post PPV) occurs in a significant number of patients. Although the rate of postvitrectomy retinal detachment appeared to decrease with time, this trend may change with further follow up in our more recent series.

Keywords: retinal detachment • retina