Phacoemulsification and lens implantation after pars plana vitrectomy

doi:10.1016/S0161-6420(98)93133-5

Ophthalmology

Volume 105, Issue 2, February 1998, Pages 287-294

https://doi.org/10.1016/S0161-6420(98)93133-5 Get rights and content

Objective:

This study aimed to describe the intraoperative and postoperative complications and visual acuity outcomes of patients undergoing Kelman phacoemulsification (KPE) and intraocular lens (IOL) implantation after pars plana vitrectomy (PPV).

Design:

The study design was a retrospective review of a consecutive surgical series.

Participants:

Forty-four eyes of 43 patients who underwent surgery at the Jules Stein Eye Institute, Los Angeles, California, or Advanced Vision Care, West Hills, California, were studied.

Intervention:

Office records, referring retina specialists' records, and operative reports were reviewed for demographic information, indications for PPV, preoperative cataract severity, unplanned intraoperative events and complications, early and late postoperative complications, and postoperative visual acuities.

Main Outcome Measures:

Complications and postoperative visual acuities were measured.

Results:

The mean interval from PPV to KPE was 20 months. The mean interval from KPE to final examination was 19 months. Primary indications for PPV included development of a macular epiretinal membrane, macular hole, proliferative diabetic retinopathy, retinal detachment, vitreous abscess, and vitreous hemorrhage. The degree of nuclear sclerosis in postvitrectomy eyes was greater than that in typical cataract eyes (P = 0.00002). The most common intraoperative problem was the discovery of a posterior capsule plaque. In a few cases, surgery was made difficult by unusual fluctuations in anterior chamber depth and lens zonule instability. The most common early postoperative complication was corneal edema; the most common late complication was the need for neodymium:YAG (Nd:YAG) laser posterior capsulotomy. An IOL was implanted in every eye. There were no retinal detachments. Median visual acuity improved from 20/125 before cataract surgery to 20/40 6 weeks after surgery to 20/30 on final examination. Visual acuity of 20/40 or better was achieved by 63.6% of eyes at 6 weeks and by 72.7% of eyes by final examination.

Conclusions:

Kelman phacoemulsification and IOL implantation can be performed safely after PPV. Intraoperative and postoperative complications are uncommon. Pre-existing posterior segment pathology limits the ultimate improvement in visual acuity, but substantial gains in visual acuity are realized by most patients.

References (38)

NovakMA et al.
The crystalline lens after vitrectomy for diabetic retinopathy
Ophthalmology
(1984)
BlankenshipGW et al.
Long-term diabetic vitrectomy results
Report of 10 year follow-up
Ophthalmology
(1985)
MargherioRR et al.
Removal of epimacular membranes
Ophthalmology
(1985)
McDonaldHR et al.
Surgical management of idiopathic epiretinal membranes
Ophthalmology
(1986)
HuttonWL et al.
Cataract extraction in the diabetic eye after vitrectomy
Am J Ophthalmol
(1987)
de BustrosS et al.
Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes
Am J Ophthalmol
(1988)
CherfanGM et al.
Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker
Am J Ophthalmol
(1991)
PesinSR et al.
Vitrectomy for premacular fibroplasia
Prognostic factors, long-term follow-up, and time course of visual improvement
Ophthalmology
(1991)
ThompsonJT et al.
Progression of nuclear sclerosis and long-term visual results of vitrectomy with transforming growth factor beta-2 for macular holes
Am J Ophthalmol
(1995)
MelbergNS et al.
Nuclear sclerotic cataract after vitrectomy in patients younger than 50 years of age
Ophthalmology
(1995)

OguraY et al.

Quantitative analysis of lens changes after vitrectomy by fluorophotometry

Am J Ophthalmol

(1991)

LuckeKH et al.

Long-term results of vitrectomy and silicone oil in 500 cases of complicated retinal detachments

Am J Ophthalmol

(1987)

FedermanJL et al.

Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery

Ophthalmology

(1988)

LeamingDV

Practice styles and preferences of ASCRS members—1995 survey

J Cataract Refract Surg

(1996)

FeilSH et al.

Astigmatic decay following small incision, self-sealing cataract surgery: one-year follow-up

J Cataract Refract Surg

(1995)

GrossRH et al.

Corneal astigmatism after phacoemulsification and lens implantation through unsutured scleral and corneal tunnel incisions

Am J Ophthalmol

(1996)

SmiddyWE et al.

Cataract extraction after vitrectomy

Ophthalmology

(1987)

SaundersDC et al.

Extracapsular cataract extraction after vitrectomy

J Cataract Refract Surg

(1996)

TielschJM et al.

Risk factors for retinal detachment after cataract surgery

A population-based case-control study

Ophthalmology

(1996)

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: Supported in part by a Presidential Scholarship to Dr. Grusha from the Russian Federation State Committee for Higher Education.

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