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

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.