Cataract formation and progression in patients less than 50 years following pars plana vitrectomy (PPV)

Abstract

Purpose : To measure the rate of cataract development and progression of nuclear sclerotic (NSC), posterior subcapsular (PSC) and cortical spoking (CS) cataracts in non-diabetic patients younger than 50 years of age following a pars plana vitrectomy.

Methods : Clinical records of 27 eyes of 27 patients that had undergone a pars plana vitrectomy younger than 50 years of age were retrospectively reviewed. NSC, PSC and CS scores were recorded preoperatively, 1, 3, 6, 9, 12 months following surgery and at final examination. Twenty-seven eyes were graded on a scale of 0 to 4.0 using the lens opacities classification system LOCS II prior and subsequent to pars plana vitrectomy for macular hole, epiretinal membranes and vitreous hemorrhage. Linear regression analysis was performed to compare the rate of change in cataract score over time.

Results : The mean age at surgery was 29.8 ± 13.5 years in 27 eyes with a median follow-up of 12 months. We observed no difference in NSC and PSC progression between baseline and final examination for 85% of patients and 100% of patients for CS. Two patients developed NSC, two developed PSC and another two developed both within 12 months. The mean progression between baseline and final examination while still phakic for NSC, PSC and CS were 0.24 ± 0.64, 0.21 ± 0.63, and 0, respectively. Linear regression analysis shows minimal increase in NSC (+0.09/year, p<0.001, R² =+0.350), a slight increase in PSC (+0.16/year, p<0.001, R² =+0.861), and a minimal decrease in CS (-0.02/year, p<0.05, R²=-0.09). PSC scores show a strong correlation with elapsed time since surgery, NSC scores show moderate correlation and CS scores show no correlation. Prior studies of nuclear sclerosis following vitrectomy in patients older than 50 years show an increase of +0.812/year. Younger patients are relatively protected against lens oxidation, which is an important factor in nuclear sclerosis progression following vitrectomy.

Conclusions : Our findings suggest there is a minimal increase in NSC and PSC scores for patients younger than 50 years following pars plana vitrectomy with no change in CS. Cataract progression is not a significant factor in the first few years following vitrectomy in patients younger than 50 years. This may have implications in the development of therapies to try to prevent nuclear sclerosis progression in patients over 50 years of age.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.