Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments.

Abstract

PURPOSE:

To investigate the clinical features, visual acuity outcomes, and adverse events in patients with retained lens fragments managed by pars plana vitrectomy (PPV).

DESIGN:

Retrospective, noncomparative, consecutive case series.

METHODS:

Medical records of all patients who underwent PPV for retained lens fragments at Bascom Palmer Eye Institute during the 12-year interval between January 1, 1990, and December 31, 2001, were reviewed.

RESULTS:

The study included 343 eyes of 343 patients, with a median age of 76 years and a median follow-up after PPV of 8 months. The median interval between cataract surgery and PPV was 12 days. Visual acuity was >or=20/40 in 29 (9%) patients preoperatively and 190 (56%) at last follow-up (P < 0.001). Visual acuity was <or=20/200 in 224 (66%) patients preoperatively and 67 (20%) at last follow-up (P < 0.001). An intraocular pressure (IOP) >or=30 mmHg was present in 87 (25%) eyes preoperatively and 7 (2%) at last follow-up (P < 0.001); the number of patients on antiglaucoma medications at these two time points was 135 (40%) and 96 (29%), respectively (P = 0.001). Among the 148 (44%) patients with final vision <20/40, the primary cause of visual impairment was cystoid macular edema (CME) in 41 (29%), preexisting ocular disease in 34 (24%), corneal edema in 22 (15%), history of retinal detachment (RD) in 19 (13%), epiretinal membrane in 6 (4%), and other causes in 21 (15%). Significant predictors of better final visual acuity include better presenting visual acuity (P < 0.001), presence of an intraocular lens (i.e., no aphakia) before PPV (P = 0.026), no suprachoroidal hemorrhage (P = 0.010), no serous choroidal detachment (P = 0.037), no RD (P = 0.005), no CME (P = 0.038), and no additional surgery after the PPV (P < 0.001). Timing of PPV (i.e., <or=1 week versus >1 to <or=4 weeks versus >4 to <or=12 weeks versus >12 weeks between cataract surgery and PPV) was not significantly associated with final visual acuity or IOP outcome; there was also no significant difference in acuity or IOP outcome between patients who underwent PPV on the same day as cataract surgery compared with all other patients.

CONCLUSIONS:

The most important predictor of final visual acuity after PPV for retained lens fragments is a less complicated clinical course (e.g., no suprachoroidal hemorrhage, no RD, no CME, and no additional surgery after PPV). The most common cause of decreased final vision was CME.

• Authors: Ingrid U Scott, Harry W Flynn Jr, William E Smiddy, Timothy G Murray, Jeffrey K Moore, Dagmar R Lemus, William J Feuer
• Journal: Ophthalmology (Ophthalmology) Vol. 110 Issue 8 Pg. 1567-72 (Aug 2003) ISSN: 0161-6420 [Print] United States
• PMID: 12917174 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cataract Extraction (adverse effects)
• Humans
• Intraocular Pressure
• Intraoperative Complications
• Lens Subluxation (etiology, physiopathology, surgery)
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Visual Acuity (physiology)
• Vitrectomy (methods)