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Travis Peck, Asima Bajwa, Janice Park, Yevgeniy Shildkrot; Timing of Pars Plana Vitrectomy for Retained Lens Fragments after Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2809.
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© ARVO (1962-2015); The Authors (2016-present)
Controversy exists regarding the optimal time for surgical intervention when lens fragments are retained in the posterior segment after cataract surgery. We performed a retrospective, observational clinical study to compare the outcomes of early versus late vitrectomy (PPV) in these patients.
We reviewed the records of all patients who underwent PPV for retained lens fragments at the University of Virginia over a fourteen year period (2002-2015). 41 eyes of 41 patients who had clinical examinations documented before cataract surgery, between cataract surgery and PPV, and at least 90 days after PPV were included in the study. Patients were divided into 2 groups: the early procedure group had PPV within 7 days of initial cataract surgery, while the late procedure group had PPV more then 7 days after cataract surgery.
Mean follow-up time was 759 days (range 95 days-13 years). Final visual acuity of 20/40 or better was seen in 58.5% of the study population with a mean visual acuity of 0.34 ± 0.56. At the final follow-up, there was no significant difference in visual acuity between the early (logMAR, 0.41) and the late (logMAR, 0.45) vitrectomy groups. There were no differences in rates of glaucoma, retinal detachment, or cystoid macular edema between the groups. Factors associated with final visual acuity of worse than 20/40 were diabetes mellitus (p=0.047), placement of anterior chamber intraocular lens at cataract surgery (p=0.003), cortical as opposed to nuclear retained lens fragments (p=0.005), post-cataract extraction complications (p=0.002), and additional surgery after vitrectomy (p=0.005).
Clinical outcomes were not affected by the timing of PPV in this patient population. Worse final visual acuity was seen in patients with baseline diagnosis of diabetes mellitus and in those who experienced post-operative complications. A prospective, randomized study could more definitely answer whether a trial of medical management in patients with retained lens fragments is indicated.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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