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Erschienen in: International Ophthalmology 6/2018

27.09.2017 | Review

Timing of vitrectomy for retained lens fragments after cataract surgery

verfasst von: Travis Peck, Janice Park, Asima Bajwa, Yevgeniy Shildkrot

Erschienen in: International Ophthalmology | Ausgabe 6/2018

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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.
Literatur
1.
Zurück zum Zitat 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):587–594CrossRef 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):587–594CrossRef
2.
Zurück zum Zitat Pande M, Dabbs TR (1996) Incidence of lens matter dislocation during phacoemulsification. J Cataract Refract Surg 22(6):737–742CrossRef Pande M, Dabbs TR (1996) Incidence of lens matter dislocation during phacoemulsification. J Cataract Refract Surg 22(6):737–742CrossRef
3.
Zurück zum Zitat 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 8:2261–2276PubMedPubMedCentral 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 8:2261–2276PubMedPubMedCentral
4.
Zurück zum Zitat 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):89–93CrossRef 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):89–93CrossRef
5.
Zurück zum Zitat Cohen SM, Davis A, Cukrowski C (2006) Cystoid macular edema after pars plana vitrectomy for retained lens fragments. J Cataract Refract Surg 32(9):1521–1526CrossRef Cohen SM, Davis A, Cukrowski C (2006) Cystoid macular edema after pars plana vitrectomy for retained lens fragments. J Cataract Refract Surg 32(9):1521–1526CrossRef
6.
Zurück zum Zitat Kim IK, Miller JW (2002) Management of dislocated lens material. Semin Ophthalmol 17(3–4):162–166CrossRef Kim IK, Miller JW (2002) Management of dislocated lens material. Semin Ophthalmol 17(3–4):162–166CrossRef
7.
Zurück zum Zitat 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) CrossRef 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) CrossRef
8.
Zurück zum Zitat 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) CrossRef 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) CrossRef
9.
Zurück zum Zitat Blodi BA, Flynn HW, Blodi CF, Folk JC, Daily MJ (1992) Retained nuclei after cataract surgery. Ophthalmology 99(1):41–44CrossRef Blodi BA, Flynn HW, Blodi CF, Folk JC, Daily MJ (1992) Retained nuclei after cataract surgery. Ophthalmology 99(1):41–44CrossRef
10.
Zurück zum Zitat 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):277–283CrossRef 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):277–283CrossRef
11.
Zurück zum Zitat Merani R, Hunyor AP (2009) Medical versus surgical management of retained lens fragments. J Cataract Refract Surg 35(12):2181 (author reply 2181) CrossRef Merani R, Hunyor AP (2009) Medical versus surgical management of retained lens fragments. J Cataract Refract Surg 35(12):2181 (author reply 2181) CrossRef
12.
Zurück zum Zitat 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):1567–1572CrossRef 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):1567–1572CrossRef
13.
Zurück zum Zitat 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):1534–1540CrossRef 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):1534–1540CrossRef
14.
Zurück zum Zitat 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):454–459CrossRef 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):454–459CrossRef
15.
Zurück zum Zitat 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):1969–1976CrossRef 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):1969–1976CrossRef
16.
Zurück zum Zitat 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):101–108CrossRef 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):101–108CrossRef
17.
Zurück zum Zitat 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):345–357CrossRef 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):345–357CrossRef
18.
Zurück zum Zitat Aasuri MK, Kompella VB, Majji AB (2001) Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 27(9):1428–1432CrossRef Aasuri MK, Kompella VB, Majji AB (2001) Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 27(9):1428–1432CrossRef
19.
Zurück zum Zitat Kapusta MA, Chen JC, Lam WC (1996) Outcomes of dropped nucleus during phacoemulsification. Ophthalmology 103(8):1184–1187CrossRef Kapusta MA, Chen JC, Lam WC (1996) Outcomes of dropped nucleus during phacoemulsification. Ophthalmology 103(8):1184–1187CrossRef
20.
Zurück zum Zitat 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):505–512PubMedPubMedCentral 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):505–512PubMedPubMedCentral
21.
Zurück zum Zitat 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):677–679CrossRef 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):677–679CrossRef
22.
Zurück zum Zitat Oruc S, Kaplan HJ (2001) Outcome of vitrectomy for retained lens fragments after phacoemulsification. Ocul Immunol Inflamm 9(1):41–47CrossRef Oruc S, Kaplan HJ (2001) Outcome of vitrectomy for retained lens fragments after phacoemulsification. Ocul Immunol Inflamm 9(1):41–47CrossRef
23.
Zurück zum Zitat 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):183–187CrossRef 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):183–187CrossRef
24.
Zurück zum Zitat Al-Amri AM (2008) Visual outcome of pars plana vitrectomy for retained lens fragments after phacoemulsification. Middle East Afr J Ophthalmol 15(3):107–111CrossRef Al-Amri AM (2008) Visual outcome of pars plana vitrectomy for retained lens fragments after phacoemulsification. Middle East Afr J Ophthalmol 15(3):107–111CrossRef
25.
Zurück zum Zitat 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):13–16CrossRef 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):13–16CrossRef
26.
Zurück zum Zitat Ho LY, Walsh MK, Hassan TS (2010) 25-Gauge pars plana vitrectomy for retained lens fragments. Retina 30(6):843–849CrossRef Ho LY, Walsh MK, Hassan TS (2010) 25-Gauge pars plana vitrectomy for retained lens fragments. Retina 30(6):843–849CrossRef
27.
Zurück zum Zitat 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):2106–2110CrossRef 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):2106–2110CrossRef
28.
Zurück zum Zitat Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L (1996) Outcomes of vitrectomy for retained lens fragments. Ophthalmology 103(6):971–976CrossRef Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L (1996) Outcomes of vitrectomy for retained lens fragments. Ophthalmology 103(6):971–976CrossRef
29.
Zurück zum Zitat 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):741–747CrossRef 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):741–747CrossRef
30.
Zurück zum Zitat 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 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
31.
Zurück zum Zitat 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):1985–1988CrossRef 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):1985–1988CrossRef
32.
Zurück zum Zitat 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 6:1135–1148PubMedPubMedCentral 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 6:1135–1148PubMedPubMedCentral
33.
Zurück zum Zitat Gonvers M (1994) New approach to managing vitreous loss and dislocated lens fragments during phacoemulsification. J Cataract Refract Surg 20(3):346–349CrossRef Gonvers M (1994) New approach to managing vitreous loss and dislocated lens fragments during phacoemulsification. J Cataract Refract Surg 20(3):346–349CrossRef
34.
Zurück zum Zitat Kim JE, Flynn HW, Smiddy WE et al (1994) Retained lens fragments after phacoemulsification. Ophthalmology 101(11):1827–1832CrossRef Kim JE, Flynn HW, Smiddy WE et al (1994) Retained lens fragments after phacoemulsification. Ophthalmology 101(11):1827–1832CrossRef
35.
Zurück zum Zitat 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):1038–1040CrossRef 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):1038–1040CrossRef
36.
Zurück zum Zitat 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):1633–1637CrossRef 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):1633–1637CrossRef
37.
Zurück zum Zitat 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):1422–1429PubMedPubMedCentral 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):1422–1429PubMedPubMedCentral
Metadaten
Titel
Timing of vitrectomy for retained lens fragments after cataract surgery
verfasst von
Travis Peck
Janice Park
Asima Bajwa
Yevgeniy Shildkrot
Publikationsdatum
27.09.2017
Verlag
Springer Netherlands
Erschienen in
International Ophthalmology / Ausgabe 6/2018
Print ISSN: 0165-5701
Elektronische ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-017-0719-8

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