Orlin Anton, Parlitsis George, Chiu Ya-Lin, D'Amico Donald J, Chan Robison V Paul, Kiss Szilárd
*Department of Ophthalmology, Weill Cornell Medical College, New York, New York; and †Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York.
Retina. 2014 Oct;34(10):1969-76. doi: 10.1097/IAE.0000000000000214.
Intravitreal retained lens fragments are a rare but potentially serious complication of phacoemulsification. The purpose of this study was to compare same setting ("no wait") vitrectomy with delayed surgery in the management of retained lens fragments in a single academic setting.
This study is a retrospective nonrandomized study of all patients undergoing pars plana vitrectomy for retained lens fragments after cataract surgery from 2007 to 2012. Outcomes included visual acuity and the development of various complications such as retinal detachment, elevated intraocular pressure >30 mmHg, and cystoid macular edema. Multivariate analysis was performed to adjust for potentially confounding variables such as age and preoperative visual acuity.
Twenty-eight consecutive eyes (13 same setting, 15 delayed setting) were included in the analysis. Patients in the same setting group were older than in the delayed group (81.00 vs. 72.87 years, P = 0.053). No other preoperative differences existed between the groups (axial length, preoperative vision, and intraocular pressure). The mean time to pars plana vitrectomy in the delayed group was 26.6 days (range, 1-91 days). The mean follow-up time was 363 days (same setting) and 643 days (delayed). At the most recent follow-up, no significant difference existed in mean vision between the same setting (logMAR, 0.42) and the delayed group (logMAR, 0.57) (P = 0.132). Multivariate analysis showed no difference in final vision when adjusting for age and preoperative vision. Although there was a trend for eyes in the same setting group to obtain good vision (≥ 20/40) faster, a higher percentage of eyes in the delayed group obtained good vision at the most recent follow-up (66.7 vs. 23.1%, P = 0.02). More eyes in the delayed group had an intraocular pressure >30 at any point (P = 0.055). There was no significant difference between the groups in any other complications such as retinal detachment, choroidal detachment, and cystoid macular edema during the follow-up.
In this cohort, same setting pars plana vitrectomy offers no significant visual acuity advantage over delayed pars plana vitrectomy in patients with retained lens fragments. Fewer eyes in the same setting group "ever" had an intraocular pressure ≥ 30 during follow-up, whereas no other complication differences were seen between the groups.
玻璃体腔内残留晶状体碎片是白内障超声乳化手术中一种罕见但可能严重的并发症。本研究的目的是在单一学术环境中比较同期（“不等待”）玻璃体切除术与延迟手术治疗残留晶状体碎片的效果。
本研究是一项回顾性非随机研究，纳入了2007年至2012年因白内障手术后残留晶状体碎片而接受玻璃体切除术的所有患者。观察指标包括视力以及各种并发症的发生情况，如视网膜脱离、眼压升高>30 mmHg和黄斑囊样水肿。进行多因素分析以调整可能存在的混杂变量，如年龄和术前视力。
分析纳入了连续入选的28只眼（13只同期手术，15只延迟手术）。同期手术组患者的年龄大于延迟手术组（81.00岁对72.87岁，P = 0.053）。两组之间术前无其他差异（眼轴长度、术前视力和眼压）。延迟手术组行玻璃体切除术的平均时间为26.6天（范围1 - 91天）。平均随访时间为同期手术组363天，延迟手术组643天。在最近一次随访时，同期手术组（logMAR，0.42）和延迟手术组（logMAR，0.57）的平均视力无显著差异（P = 0.132）。多因素分析显示，在调整年龄和术前视力后，最终视力无差异。尽管同期手术组的眼似乎有更快获得良好视力（≥20/40）的趋势，但在最近一次随访时，延迟手术组获得良好视力的眼的比例更高（66.7%对23.1%，P = 0.02）。延迟手术组在随访期间任何时间眼压>30的眼更多（P = 0.055）。随访期间，两组在视网膜脱离、脉络膜脱离和黄斑囊样水肿等任何其他并发症方面无显著差异。
在该队列中，对于残留晶状体碎片的患者，同期玻璃体切除术与延迟玻璃体切除术相比，在视力方面无显著优势。同期手术组在随访期间“曾经”眼压≥30的眼较少，而两组之间未见其他并发症差异。
