Abstract
Purpose
To determine the outcomes of early (less than 7 inter-operative days) versus late (7 or greater inter-operative days) vitrectomy in patients with retained lens fragments in the posterior segment after cataract surgery.
Methods
This was a retrospective review of all patients underwent pars plana vitrectomy for retained lens fragments at the University of Virginia Hospital from 2002 to 2015.
Results
Forty-one eyes were included in the analysis. Mean follow-up time was 25.3 months (range 3.2 months-13 years). Patients in the early vitrectomy group had poorer baseline visual acuity than those in the late vitrectomy group (mean logMAR, 1.10 vs. 0.53, p = 0.030). No other pre-operative differences existed between the two groups. At the final follow-up, there was no significant difference in visual acuity between the early (mean logMAR, 0.41) and the late (mean 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, placement of anterior chamber intraocular lens at cataract surgery, cortical as opposed to nuclear retained lens fragments, post-cataract extraction complications, need for glaucoma medications, and additional surgery after vitrectomy. Separate analysis was done for patients with pre-existing eye disease resulting in worse than 20/40 vision, which showed.
Conclusion
Clinical outcomes were similar in patients undergoing early and late vitrectomy. Patients with poorer baseline visual acuity were more likely to receive early vitrectomy. Worse final visual acuity was seen in patients with baseline diagnosis of diabetes and in those who experienced post-operative complications.
Similar content being viewed by others
References
Ho LY, Doft BH, Wang L, Bunker CH (2009) Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Am J Ophthalmol 147(4):587–594
Pande M, Dabbs TR (1996) Incidence of lens matter dislocation during phacoemulsification. J Cataract Refract Surg 22(6):737–742
Vanner EA, Stewart MW (2014) Meta-analysis comparing same-day versus delayed vitrectomy clinical outcomes for intravitreal retained lens fragments after age-related cataract surgery. Clin Ophthalmol 8:2261–2276
Chalam KV, Murthy RK, Priluck JC, Khetpal V, Gupta SK (2015) Concurrent removal of intravitreal lens fragments after phacoemulsification with pars plana vitrectomy prevents development of retinal detachment. Int J Ophthalmol 8(1):89–93
Cohen SM, Davis A, Cukrowski C (2006) Cystoid macular edema after pars plana vitrectomy for retained lens fragments. J Cataract Refract Surg 32(9):1521–1526
Kim IK, Miller JW (2002) Management of dislocated lens material. Semin Ophthalmol 17(3–4):162–166
Moore JK, Scott IU, Flynn HW et al (2003) Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Ophthalmology 110(4):709–713 (discussion 713–714)
Vilar NF, Flynn HW, Smiddy WE, Murray TG, Davis JL, Rubsamen PE (1997) Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Ophthalmology 104(5):787–791 (discussion 787–794)
Blodi BA, Flynn HW, Blodi CF, Folk JC, Daily MJ (1992) Retained nuclei after cataract surgery. Ophthalmology 99(1):41–44
Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT (2008) Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Ophthalmologica 222(4):277–283
Merani R, Hunyor AP (2009) Medical versus surgical management of retained lens fragments. J Cataract Refract Surg 35(12):2181 (author reply 2181)
Scott IU, Flynn HW, Smiddy WE et al (2003) Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Ophthalmology 110(8):1567–1572
Colyer MH, Berinstein DM, Khan NJ et al (2011) Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Retina 31(8):1534–1540
Modi YS, Epstein A, Smiddy WE, Murray TG, Feuer W, Flynn HW (2013) Retained lens fragments after cataract surgery: outcomes of same-day versus later pars plana vitrectomy. Am J Ophthalmol 156(3):454–459
Orlin A, Parlitsis G, Chiu YL, D’Amico DJ, Chan RV, Kiss S (2014) A comparison of same setting versus delayed vitrectomy in the management of retained lens fragments after cataract surgery. Retina 34(10):1969–1976
Scupola A, Abed E, Sammarco MG et al (2015) 25-Gauge pars plana vitrectomy for retained lens fragments in complicated cataract surgery. Ophthalmologica 234(2):101–108
Vanner EA, Stewart MW (2011) Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis. Am J Ophthalmol 152(3):345–357
Aasuri MK, Kompella VB, Majji AB (2001) Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 27(9):1428–1432
Kapusta MA, Chen JC, Lam WC (1996) Outcomes of dropped nucleus during phacoemulsification. Ophthalmology 103(8):1184–1187
Romero-Aroca P, Fernández-Ballart J, Méndez-Marín I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA (2007) Management of nucleus loss into the vitreous: long term follow up in 63 patients. Clin Ophthalmol 1(4):505–512
Olsson RB, Ritland JS, Bjørnsson OM, Syrdalen P, Eide N, Overgård R (2000) A retrospective study of patients with retained nuclear fragments after cataract extraction. Acta Ophthalmol Scand 78(6):677–679
Oruc S, Kaplan HJ (2001) Outcome of vitrectomy for retained lens fragments after phacoemulsification. Ocul Immunol Inflamm 9(1):41–47
Smiddy WE, Guererro JL, Pinto R, Feuer W (2003) Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Am J Ophthalmol 135(2):183–187
Al-Amri AM (2008) Visual outcome of pars plana vitrectomy for retained lens fragments after phacoemulsification. Middle East Afr J Ophthalmol 15(3):107–111
Kim NR, Yoon JH, Kang SM, Chin HS (2009) Intravitreal triamcinolone acetonide injection at the time of pars plana vitrectomy for retained lens material. Kor J Ophthalmol 23(1):13–16
Ho LY, Walsh MK, Hassan TS (2010) 25-Gauge pars plana vitrectomy for retained lens fragments. Retina 30(6):843–849
Ho SF, Zaman A (2007) Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. J Cataract Refract Surg 33(12):2106–2110
Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L (1996) Outcomes of vitrectomy for retained lens fragments. Ophthalmology 103(6):971–976
Moisseiev E, Kinori M, Glovinsky Y, Loewenstein A, Moisseiev J, Barak A (2011) Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments. Eur J Ophthalmol 21(6):741–747
Smiddy W, Flynn H (1996) Managing retained lens fragments and dislocated posterior chamber IOLs after cataract surgery. Focal points: clinical modules for ophthalmologists. Vol Module 7. San Francisco: American Academy of Ophthalmology
Stefaniotou M, Aspiotis M, Pappa C, Eftaxias V, Psilas K (2003) Timing of dislocated nuclear fragment management after cataract surgery. J Cataract Refract Surg 29(10):1985–1988
Vanner EA, Stewart MW, Liesegang TJ, Bendel RE, Bolling JP, Hasan SA (2012) A retrospective cohort study of clinical outcomes for intravitreal crystalline retained lens fragments after age-related cataract surgery: a comparison of same-day versus delayed vitrectomy. Clin Ophthalmol 6:1135–1148
Gonvers M (1994) New approach to managing vitreous loss and dislocated lens fragments during phacoemulsification. J Cataract Refract Surg 20(3):346–349
Kim JE, Flynn HW, Smiddy WE et al (1994) Retained lens fragments after phacoemulsification. Ophthalmology 101(11):1827–1832
Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S (2001) Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Br J Ophthalmol 85(9):1038–1040
Wilkinson CP, Green WR (2001) Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Ophthalmology 108(9):1633–1637
Salehi A, Razmju H, Beni AN, Beni ZN (2011) Visual outcome of early and late pars plana vitrectomy in patients with dropped nucleus during phacoemulsification. J Res Med Sci 16(11):1422–1429
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Peck, T., Park, J., Bajwa, A. et al. Timing of vitrectomy for retained lens fragments after cataract surgery. Int Ophthalmol 38, 2699–2707 (2018). https://doi.org/10.1007/s10792-017-0719-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-017-0719-8