[Clinical investigation on anterior capsule preservation in surgical management for severe proliferative diabetic retinopathy].

OBJECTIVE

To report the outcomes of patients treated with the anterior capsule preservation technique used in surgical management for severe proliferative diabetic retinopathy.

METHODS

Anterior capsule was preserved following pars plana lensectomy or fragmentation during vitrectomy for cataract patients with proliferative diabetic retinopathy, all eyes presented tractional and tractional/rhegmatogenous retinal detachment and involvement of posterior retina. Postoperatively, the transparency of anterior capsule was classified into A, B, C and D degrees according to the photographic record. The outcomes of visual acuity, retinal reattachment, intraocular pressure and the complications related to the operation as well as their managements were analyzed.

RESULTS

Vitrectomy, silicone oil tamponade and anterior capsule preservation were performed in 58 eyes. The transparency of the anterior capsule in these eyes was degree A in 26 eyes (44.8%); degree B in 20 eyes (34.5%); degree C in 7 eyes (12.1%) and degree D in 5 eyes (8.6%). Forty eyes (79.3%) had a postoperative best corrected visual acuity > or = 0.05, 21 eyes received secondary intraocular lens implantation. Finally, 7 eyes were classified to be silicone oil-depended eyes because of severe proliferative changes occurred and the presence of macular hole. Complications related to the operation included iris mal-cut in 1 eye, silicone oil escaped into anterior chamber in 7 eyes, iris neovascularization and new vascular glaucoma in 1 eye respectively, intraocular pressure elevation in 4 eyes, secondary pre-macular membrane formation in 11 eyes and macular hole in 2 eyes.

CONCLUSIONS

The anterior capsule preservation procedure and selective secondary intraocular lens implantation is an acceptable method in surgical management for severe proliferative diabetic retinopathy. The main causes of the opacification of anterior capsule are the proliferation of residual lens epithelial cells and blood deposit on the posterior surface. Silicone oil escaped into the anterior chamber is one of the most common complications related to this procedure.