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Imran Khatri, Matthew D Karl, Matthew P. Ohr; Frequency and Type of Incidentally Found Pathology During Pars Plana Vitrectomy with Secondary Intraocular Lens Placement. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3670.
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There is a lack of literature describing the frequency of incidentally found pathology during pars plana vitrectomy (PPV) with insertion of a secondary intraocular lens (IOL). We performed a retrospective chart review to report on the frequency and type of pathology discovered during PPV with secondary IOL insertion.
Operative notes for surgeries performed by a single surgeon at an academic tertiary hospital between January 1, 2015 and January 1, 2020 were reviewed. A total of 208 PPV with insertion of secondary IOL surgeries were performed during this time. Eyes with a prior history of significant trauma (n=31), history of complicated cataract surgery at the time of initial IOL insertion (n=11), a history of prior PPV in the operative eye (n=16), or with inadequate data in patient chart (n=3), were excluded (n=61). Variables recorded from charts were age, gender, laterality, lens status, presence and type of peripheral retinal pathology on both pre-operative and intra-op scleral depressed exam, whether intra-operative intervention was performed for this pathology, and whether secondary IOL placement was deferred due to pathology discovered.
Out of the initial 208 cases reviewed, 146 eyes from 140 patients (89 male, 51 female) met inclusion criteria. Of these 146 eyes, 30 (20.5%) had incidental pathology discovered intraoperatively where treatment was deemed necessary. The attached figure displays the type of pathology found. Unspecified retinal breaks were found in 10 out of 30 eyes, retinal holes in 5 out of 30, horseshoe tears in 2 out of 30, retinal tufts in 5 out of 30, lattice degeneration in 8 out of 30, retinal hemorrhage in 1 out of 30, and an ora bay in 1 out of 30.Of the total 146 eyes, 18 (12.3%) were treated with laser, 14 (9.6%) were treated with cryotherapy, and 11 (8.2%) received gas (C3F8, n = 4 [2.7%]; SF6, n = 8 [5.5%]). Of the 146 eyes, 8 (5.48%) were discovered to have peripheral pathology that deferred secondary IOL placement and required a second surgery for lens placement, if the patient desired.
Incidentally discovered pathology is common during pars plana vitrectomy for placement of a secondary intraocular lens. Surgeons should proceed cautiously and perform careful scleral depressed exam intraoperatively to minimize risk of leaving untreated pathology in vitrectomized eyes.
This is a 2021 ARVO Annual Meeting abstract.
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