Abstract
Purpose :
To analyze outcomes and complications related to cataract surgery complicated by retained lens material requiring pars plana vitrectomy/lensectomy (PPV/PPL) in a large county hospital where procedures are performed by trainees.
Methods :
Retrospective chart review of patients who underwent PPV/PPL for retained lens fragment (RLF) from 2010-2016. Those with RLF managed by anterior segment surgery alone were excluded. Unpaired and paired t-tests and analysis of variance were used to identify differences in the means. Statistical significance was defined as p-value <0.05.
Results :
Twenty patients met inclusion criteria. Mean preoperative visual acuity (Va) was logMAR 1.7 (Snellen 3/200). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications, such as history of vitrectomy.
The average rate of RLF requiring PPV/PPL was 0.75%. In 39% of cases, the entire lens was dropped to the vitreous cavity; 17% dropped less than half of the lens nucleus. Nine patients (45%) had an intraocular lens (IOL) placed. Most patients underwent PPV/PPL within 1 week (median 6.5 days). In 4 cases, a secondary IOL was concurrently placed at that time.
Complications following PPV/PPL included hypotony (5 patients), corneal edema (4), elevated IOP (3), and cystoid macular edema (3). These did not affect final Va outcomes. There were no cases of postoperative retinal detachment, suprachoroidal hemorrhage, or endophthalmitis.
At 12 month follow-up, significant Va improvement was observed with final mean Va logMAR 0.6 (± 0.75; p=0.001; Snellen 20/80). Six patients were aphakic; 14 were pseudophakic. A denser initial nuclear cataract was associated with greater improvement in Va (p<0.01). Factors associated with less Va improvement were older age, larger fraction of lens dropped, and longer time lapse from cataract surgery to PPV/PPL (p<0.01).
Conclusions :
Despite patients with more advanced pathology and trainees performing their surgeries, rates of cataract surgery-associated RLF requiring PPV/PPL at Ben Taub General Hospital are similar to reported rates in the literature. Although their recovery period may be prolonged, these patients ultimately benefit from significant visual gains.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.