Retrospective analysis of risk factors for unplanned anterior vitrectomy during planned cataract ultrasonic phacoemulsification in Chinese adult patients.

BACKGROUND/AIMS: Although ultrasonic phacoemulsification cataract (CUP) surgery has been widely used for cataracts, unplanned vitrectomy (UAV) is sometimes required during CUP. Thus, the aim is to identify 16 risk factors (systematic: age, gender, the side of the eyes, smoking, hypertension, diabetes, coronary heart disease, and renal failure; local: filtering surgery history, glaucoma, old iritis, pupil adhesion, high myopia, lens hardness, zonular dehiscence, and combined trabeculectomy) as primary outcomes and to examine complications and visual acuity (VA) as secondary outcomes in Chinese age-related cataract patients undergoing UAV during routine CUP.

METHODS

A retrospective analysis of 676 cataract eyes as the first diagnosis was made. Eyes received CUP and intraocular lens (IOL) implantation or CUP/IOL combined with trabeculectomy. Vitrectomy and non-vitrectomy groups are divided based on eyes with or without UAV. Statistical analysis included Chi-square X test to examine the correlation between the risk factors and UAV, visual acuity, and complications.

RESULTS

The average patient's age was 72 ± 9.6 years, and 385 patients had Grade III nucleus. Sixteen eyes received concomitant UAV during CUP in the vitrectomy group and 660 eyes without UAV in the non-vitrectomy group. No statistically significant difference in demographic data was detected between the two groups. Glaucoma, chronic iritis, filtration surgery, zonular rupture, and combined trabeculectomy were identified as risk factors for UAV (p < 0.05); However, UAV was positively correlated only with filtration surgery, zonular rupture, and combined trabeculectomy. Zonular abnormality was also identified as a risk factor within a subgroup of patients solely with a history of glaucoma (n = 10) attributed to UAV (p = 0.00). Complications included intra-operative malignant glaucoma (4 cases), zonular rupture (8 cases), posterior capsular rupture (3 cases), and rupture of both posterior capsule and zonules (1 case). Fourteen cases had improved visual acuity (p < 0.05) except for one with anterior chamber hemorrhage and one without lens implantation.

CONCLUSION

Our results demonstrated that filtration surgery history, zonular rupture, or combined trabeculectomy are risk factors for cataract patients undergoing UAV during routine CUP, suggesting that evaluating risk factors is critical to minimize the incidence of UAV and post-operative complications.