Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery

Pars Plana Vitrectomy for Retained Lens Fragments After Cataract Surgery: Outcomes Based on Timing of Surgery

Purpose

To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after cataract surgery, comparing those who received pars plana vitrectomy (PPV) on the same day, within 1 week, or later than 1 week after cataract surgery.

Patients and Methods

Retrospective case series of all patients who underwent PPV for RLF at Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery.

Results

The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (P = 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (P > 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (P > 0.05).

Conclusion

In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.

[Retained lens fragments after cataract surgery: Comparison of same-day versus delayed vitrectomy]

PURPOSE

To evaluate and to compare functional outcomes and complication rates of the same-day versus delayed pars plana vitrectomy (PPV) for intravitreal retained lens fragments after cataract surgery.

METHODS

Retrospective comparative series of 135 eyes with retained lens fragments that underwent PPV between August 2014 and July 2016. Sixty-two eyes received same-day PPV (group 1) and seventy-three eyes underwent delayed PPV (group 2). Outcome measures included best-corrected visual acuity (BCVA) at 6 months and postoperative complications.

RESULTS

The mean time to PPV in group 2 was 4.3±5.3 days. Mean axial length, lens fragment size and surgical technique were comparable in both groups. At 6 months, BCVA was 0.27±0.40 logMAR in group 1, and 0.35±0.30 logMAR in group 2, with no significant difference (P=0.205). Fifty-one (82.2%) eyes in group 1 and 53 (72.6%) eyes in group 2 achieved BCVA of+0.30 logMAR (20/40) or better (P=0.183). The most common complications were macular edema, elevated intraocular pressure>25mmHg, and retinal detachment occurring respectively in 10 (16.1%) eyes, 4 (6.4%) eyes and one eye (1.6%) in group 1 and 11 (15.0%) eyes, 5 (6.8%) eyes and 2 (2.7%) eyes in group 2. Overall, the complication rate was similar in both groups (P=1).

CONCLUSION

Our study shows that visual acuity outcomes and complication rates were similar regardless of timing of the PPV. The optimal timing of surgery remains a multifactorial decision involving patient preferences, transportation, surgeon availability and severity of the initial presentation.

Contemporary Outcomes and Prognostic Factors of 23-Gauge Vitrectomy for Retained Lens Fragments After Phacoemulsification

PURPOSE

To provide data on visual acuity (VA) outcomes and prognostic factors of microincision (23-gauge) vitrectomy surgery (MIVS) for retained lens fragments after complicated cataract surgery.

DESIGN

Retrospective, interventional case series from 2012 to 2017.

METHODS

Precataract surgery and intraoperative (vitrectomy) parameters, postvitrectomy complications, and best-corrected visual acuities (BCVAs) were identified. Vitrectomy was performed as early as corneal clarity permitted. Univariate and multivariate logistic regression were used to characterize factors associated with achieving VA better than 20/40, or worse than 20/200 at 6 months.

RESULTS

This study included 291 consecutive eyes (291 patients). LogMAR BCVA improved from 0.73 ± 0.70 before cataract surgery to 0.46 ± 0.63 (P < .001) after vitrectomy. The previtrectomy VA was 1.43 ± 0.79. At 6 months, 183 (62.9%) and 45 patients (15.5%) achieved BCVAs better than 20/40 and worse than 20/200, respectively. Most frequent complications were de novo ocular hypertension (29 eyes, 10%) and transient cystoid macular edema (25 eyes, 8.6%). Postvitrectomy retinal detachment occurred in 9 eyes (3.1%). Final VA of 20/40 or better was independently associated only with better precataract surgery VA, age <75 years, absence of preexisting diabetic macular edema (DME) or postvitrectomy persistent cystoid macular edema (P < .05). Only poorer precataract surgery VA, delaying vitrectomy to later than 2 weeks, and final aphakic status were independently predictive of 20/200 or worse VA (P < .05).

CONCLUSION

Contemporary VA outcomes of 23-gauge vitrectomy for retained lens fragments are comparable with that of prior predominantly non-MIVS cohorts, but fall short of benchmarks for uncomplicated cataract surgery. IOL type or timing of placement do not impact final VA.

A Rare Case of Lens-Induced Uveitis with Proliferative Vitreoretinopathy and Massive Encapsulation of Fallen Nuclear Material

We experienced a rare case of lens-induced uveitis (LIU) with severe proliferative vitreoretinopathy (PVR) diagnosed upon finding lens nuclear material encapsulated by intravitreal proliferative tissue. A 60-year-old man was referred to our hospital for the treatment of vision loss caused by unexplained uveitis in the right eye (OD). Seven months previously, a complicated cataract surgery that required unplanned anterior vitrectomy and transscleral suture of intraocular lens was performed on that eye at another clinic. Severe inflammation with dense vitreous opacity occurred in the OD postoperatively. Although topical and oral administration of steroids reduced the inflammation 7 months after the surgery, PVR with tractional retinal detachment was developed in the OD. Pars plana vitrectomy (PPV) was performed for the treatment and diagnosis. PPV revealed the presence of lens nuclear fragments within the vitreous, which was approximately 60% the ordinary nucleus size and was encapsulated by intravitreal proliferative tissue. The nuclear fragments were extracted from a superior corneoscleral flap. Intraocular inflammation was reduced with postoperative topical and oral steroid treatments and the retina remained reattached 1 year after the PPV. In conclusion, uveitis with an episode of a complicated cataract surgery may suggest LIU.

25-Gauge Pars Plana Vitrectomy for Retained Lens Fragments in Complicated Cataract Surgery

PURPOSE

To verify the efficacy of 25-gauge pars plana vitrectomy (PPV) for the management of posteriorly dislocated lens material after complicated cataract extraction and to determine in what patients this approach offers the optimal benefit in terms of efficacy and safety, considering the amount of retained nuclear material and the duration of surgery.

METHODS

Forty eyes of 40 patients with retained lens fragments undergoing early (within 1 week) or late (within >1 week) 25-gauge PPV were retrospectively reviewed. The amount of dislocated nuclear material was graded by the surgeon intraoperatively, and the patients were divided into two groups according to the nuclear grading: group A (≤50% dropped nucleus) and group B (>50% dropped nucleus). The presence of brunescent nuclear pieces was considered. The outcomes measured included best-corrected visual acuity (BCVA) and postoperative complications such as retinal detachment, cystoid macular edema (CME) and postoperative ocular hypertension or hypotonia.

RESULTS

The patients had a mean age of 78 years. The mean preoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.57 ± 0.24 (20/80). A significant positive correlation was found between nuclear material grade and PPV duration (R2 = 0.81, p < 0.0001). None of the patients had dislocation of brunescent nuclear pieces. On postoperative day 1, the mean postoperative intraocular pressure was 16.75 ± 2.7 mm Hg, with no case of ocular hypotonia. At 6 months of follow-up, the mean logMAR BCVA improved to 0.23 ± 0.3 (20/32). Retinal detachment developed in 4 patients (10%), occurring only in patients of group B (p < 0.002). Four patients with late PPV developed postoperative CME, with no case of CME among patients with early vitrectomy (p = 0.014).

CONCLUSION

Removal of dislocated lens fragments after complicated cataract surgery can be effectively managed with 25-gauge PPV, although it appears to be most efficient for cases with a limited amount of dislocated lens material. In consideration of the higher rate of retinal detachment observed in cases of prolonged PPV time, the expected duration of surgery should be taken into account when choosing the best surgical approach. Visual outcomes are not affected by the timing of PPV, whereas early vitrectomy seems to prevent the onset of inflammatory macular edema.

A Study Investigating a Possible Link Between Lens Protein in the Vitreous Fluid of Eyes After Uncomplicated Cataract Surgery and Chronic Cystoid Macular Edema

PURPOSE

This study aimed to determine if the lens protein aquaporin 0 (AQP0) is present in the vitreous of pseudophakic eyes of patients presenting with chronic cystoid macular edema (CME).

DESIGN

A case-control study was conducted.

METHODS

Ten patients undergoing therapeutic vitrectomy for chronic CME after uncomplicated cataract surgery were enrolled in this study. Fourteen patients with pseudophakia undergoing vitrectomy surgery for indications other than CME acted as the comparison group.The vitreous fluid from the 2 groups was analyzed for the presence of the lens protein AQP0 and type II collagen (used as a positive control).

RESULTS

Type II collagen was detected in all the vitreous samples, whereas AQP0 was documented in 50% of eyes with chronic CME but was not found in the vitreous of any eyes without a documented history of CME.

CONCLUSIONS

Aquaporin 0 is found in some eyes with chronic CME after uncomplicated cataract surgery, suggesting contamination of the vitreous by lens protein may have a role in the pathogenesis of this disorder.

Retained lens fragments after cataract surgery: outcomes of same-day versus later pars plana vitrectomy

PURPOSE

To compare visual acuity outcomes and adverse events in patients with retained lens fragments who underwent same-day versus later pars plana vitrectomy (PPV).

DESIGN

Retrospective, interventional case series.

METHODS

Single-center study evaluating all patients with retained lens fragments that underwent PPV over a 22-year period (1990 through 2011).

RESULTS

The study included 569 eyes of 568 patients with a mean age of 74.6 years and a median follow-up of 8 months (range, 1 week to 100 months). One hundred seventeen patients (22%) underwent same-day vitrectomy, 131 patients (23%) underwent PPV within 1 week, and 321 patients (57%) underwent PPV more than 1 week later. Median time to vitrectomy in the same week group was 5 days, compared with 22 days in the delayed group. At the last examination, 61%, 63%, and 56% of patients undergoing PPV on the same day, within 1 week, and more than 1 week later, respectively, achieved best-corrected visual acuity (BCVA) of 20/40 or better (P = .35), and 16%, 15%, and 21%, respectively, had BCVA of 20/200 or worse (P = .29). There were no differences between groups when assessing cystoid macular edema (P = .96), retinal detachment (P = .096), elevated intraocular pressure (P = .88), or suprachoroidal hemorrhage (P = .26).

CONCLUSIONS

Patients undergoing same-day versus a later PPV (within 1 week or more than 1 week later) for retained lens fragments had similar visual acuity outcomes and complication rates. Although same-day surgery may be attractive logistically in many cases, our retrospective data suggest equivalent outcomes for surgical timing.

A retrospective cohort study of clinical outcomes for intravitreal crystalline retained lens fragments after age-related cataract surgery: a comparison of same-day versus delayed vitrectomy

BACKGROUND

This analysis compared outcomes for same-day (under a no-move, no-wait policy) versus delayed vitrectomy for intravitreal crystalline retained lens fragments after surgery for age-related cataract.

METHODS

This was a retrospective, nonrandomized treatment comparison cohort study with a consecutive series of 35 eyes (23 same-day, 12 delayed) receiving both cataract surgery and vitrectomy at the Mayo Clinic Florida between 1999 and 2010. Outcome measures included visual acuity (VA), glaucoma progression, visual utility, and complications. Several techniques (bootstrapping, robust confidence intervals, jackknifing, and a homogeneous sample) were used to reduce selection bias and increase confidence in our small sample's results.

RESULTS

No significant baseline treatment group differences. Mean previtrectomy delay (12 eyes) was 40.9 days (median 29.5, range 1-166). Mean postvitrectomy follow-up (35 eyes) was 47.5 months (median 40.5, range 3.1-123.5). Same-day patients had significantly better final VA (adjusted for age [t = -2.14, P = 0.040] and precataract surgery VA [t = -2.98, P = 0.006]); a higher rate of good final VA (≥20/40), 78.3% (18/23) versus 58.3% (7/12); a lower rate of bad final VA (≤20/200), 4.3% (1/23) versus 25.0% (3/12); and fewer final retinal conditions, 4.3% (1/23) versus 50.0% (6/12). Same-day patients also had marginally significant better mean final VA in the operated eye (20/40 versus 20/90, Z = 1.51, P = 0.130) despite poorer initial VA (20/98 versus 20/75) and higher age (3+ years), better final visual utility, and longer survival times for better VA. Among patients with preexisting glaucoma, same-day patients experienced significantly less differential (operated versus nonoperated eye) glaucoma progression.

CONCLUSION

Results favored same-day patients, who experienced better final VA and visual utility, less differential glaucoma progression, and fewer complications. Results need confirmation with larger samples.

Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis

PURPOSE

To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery.

DESIGN

Systematic review and meta-analysis of retrospective interventional cases series.

METHODS

Searches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up ≥3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal edema. Data extraction was performed twice and quality assessed. Logistic regression estimated study-level odds ratios for each additional 1-week vitrectomy delay. Meta-analysis estimated summary odds ratios using random-effects models.

RESULTS

Of 257 articles identified, there were 43 unique studies (53 articles) for the systematic review, including 27 (31 articles) for the meta-analysis. Early vitrectomies were statistically significantly associated with better outcomes for not good visual acuity (odds ratio: 1.13; 95% CI: 1.04-1.22, P = .005); bad visual acuity (odds ratio: 1.05; 95% CI: 1.01-1.09, P = .009); previtrectomy retinal detachment (odds ratio: 1.29; 95% CI: 1.01-1.65, P = .038); postvitrectomy retinal detachment (odds ratio: 1.13; 95% CI: 1.02-1.26, P = .024); increased intraocular pressure (odds ratio: 1.23; 95% CI: 1.07-1.41, P = .003); and intraocular infection/inflammation (odds ratio: 1.20; 95% CI: 1.01-1.42, P = .041). Results were robust to sensitivity analyses.

CONCLUSIONS

This systematic review and meta-analysis found significantly better outcomes (visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation) with earlier vitrectomy for retained lens fragments. Reduced vitrectomy delays may yield better patient outcomes.

Evaluating exaggerated, prolonged, or delayed postoperative intraocular inflammation

PURPOSE

To provide a diagnostic approach for the evaluation of patients with exaggerated, prolonged, or delayed postoperative intraocular inflammation.

DESIGN

Perspective.

METHODS

Selected articles on normal and abnormal postoperative intraocular inflammation were reviewed and interpreted in the context of the authors' clinical and research experience.

RESULTS

In addition to infectious endophthalmitis, a number of noninfectious conditions characterized by exaggerated, prolonged, or delayed postoperative inflammation have been described. Heuristically, increased postsurgical inflammation may be categorized by time from surgery to first recognition using the following general guidelines: as immediate and occurring within 2 days after surgery; as early and occurring after 2 days, but within the first 2 weeks, after surgery; and as delayed and occurring more than 2 weeks after surgery.

CONCLUSIONS

Although infectious endophthalmitis always must be excluded as a cause of increased postoperative intraocular inflammation, potential noninfectious causes also exist. We review both infectious and noninfectious causes of increased postoperative inflammation and provide a diagnostic framework for evaluating such patients.

Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction

PURPOSE

To determine current clinical predictors and visual outcomes of patients who undergo pars plana vitrectomy (PPV) for retained lens material.

DESIGN

Retrospective, noncomparative, consecutive case series.

METHODS

Medical records of 166 patients with complicated cataract surgery who underwent PPV for retained lens material at Retina Vitreous Consultants of Pittsburgh between January 1, 2001 and January 1, 2007 were reviewed. Main outcome measures include final visual acuity, development of glaucoma, retinal detachments, and cystoid macular edema.

RESULTS

At the final examination, 120 patients (72.3%) had a visual outcome of 20/40 or better and 18 patients (10.8%) had a visual outcome of 20/200 or worse. In patients without any preoperative eye conditions, 82.6% achieved a final vision of 20/40 or better. Multivariable analysis showed that predictors for visual outcomes of 20/40 or better were better presenting vision (P = .001), insertion of a posterior chamber lens (P = .005), and absence of preoperative eye disease (P = .001). Predictors for visual outcomes of 20/200 or worse were the absence of an anterior vitrectomy at cataract surgery (P = .005), absence of a sulcus lens (P = .011), presence of preexisting eye disease (P = .02), and development of glaucoma (P = .001). Performing a PPV within 7 days of cataract surgery was associated with a lower risk of developing glaucoma (P = .005).

CONCLUSIONS

Current techniques for management of retained lens material may contribute to improved visual outcomes based on our series. We recommend that the cataract surgeon perform an anterior vitrectomy, place a posterior chamber lens if possible, and consult a retina specialist for a PPV within 7 days to decrease the risk of developing secondary glaucoma.

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery

PURPOSE

To assess the outcome of patients who underwent instantaneous pars plana vitrectomy for dislocated lens fragments during cataract surgery.

METHODS

The medical records of 29 patients who underwent immediate pars plana vitrectomy for dislocated lens fragments at the same sitting of phacoemulsification surgery were reviewed. Data including patients' demographics, preoperative and postoperative vision, risk factors for lens fragment dislocation, and intraoperative and postoperative complications were recorded.

RESULTS

The mean follow-up period of the patients was 12.3 months (range, 3-47 months). The median preoperative visual acuity was 6/90 (range, LP to 6/15). The median final postoperative visual acuity was 6/18 (range, NLP to 6/9) and the mean improvement in vision after the operation was 4.5 lines. The commonest risk factors for dislocation of lens fragment were late detection of posterior capsule tear, splitting of anterior capsulorrhexis, and hard nucleus. After excluding nine eyes with other pre-existing ocular comorbidities, 10 (50%) eyes had a final visual acuity of 6/12 or better. Complications after surgery included three (10%) cases of retinal detachment and one (3%) patient developed epiretinal membrane. None of the patients in the study developed secondary glaucoma or cystoid macular oedema following surgery.

CONCLUSION

Immediate vitrectomy in the same sitting of the cataract surgery is a surgical option in the management of dislocated intravitreal lens fragments when vitreoretinal support is available. Most patients achieve a good visual outcome with reduced risk of secondary glaucoma and cystoid macular oedema after surgery.

Timing of dislocated nuclear fragment management after cataract surgery

PURPOSE

To determine the timing of vitrectomy in patients with dislocated nuclear fragments after phacoemulsification and to correlate timing with visual outcomes.

SETTING

University Eye Clinic of Ioannina, Ioannina, Greece.

METHODS

This was a retrospective review of the records of 26 patients who had phacoemulsification at the University Eye Clinic of Ioannina over a 5-year period. The mean age of the 13 men and 13 women was 66.9 years (range 59 to 80 years). All patients had nucleus or nuclear fragment dislocation into the vitreous cavity during phacoemulsification and had vitrectomy and removal of the dislocated nucleus. The postoperative follow-up ranged from 3 to 9 months.

RESULTS

Eight patients (30.8%) had vitrectomy at the time of phacoemulsification (Group A), 8 (30.8%) within 3 weeks (Group B), and 10 (38.5%) after more than 3 weeks (Group C). Patients in Group A did not develop complications, and 87.5% achieved a final visual acuity of 5/10 or better. In Group B, 4 patients (50%) developed moderate intraocular inflammation and 5 patients achieved a final visual acuity of 5/10 or better. Six patients in Group C (60%) had phacoanaphylactic glaucoma and 3 (30.0%), retinal detachment; 70.0% had a final visual acuity of 3/10 or worse.

CONCLUSION

Early vitrectomy (fewer than 3 weeks postoperatively) was associated with better visual results, while late vitrectomy resulted in limited visual acuity in a high percentage of patients and increased the risk for glaucoma and retinal detachment.

Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments

PURPOSE

To investigate the incidence and outcomes of retinal detachment (RD) associated with retained lens fragments removed by pars plana vitrectomy (PPV).

DESIGN

Retrospective, noncomparative, interventional consecutive case series.

PARTICIPANTS

All patients who underwent PPV for retained lens material after cataract surgery at Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001.

METHODS

Demographic and clinical data were extracted from patients' medical records.

MAIN OUTCOME MEASURES

Incidence of retinal detachment, reattachment rate, and visual acuity outcome.

RESULTS

RD occurred in 44 of 343 (12.8%) patients, including 25 (7.3%) before or during PPV and 19 (5.5%) after PPV. The RD was macula-on in 22 of 44 (50%) patients and macula-off in 22 of 44 (50%) patients. The RD was associated with a giant retinal tear in 7 of 44 (15.9%) patients, limited suprachoroidal hemorrhage in 3 of 44 (6.8%) patients, and endophthalmitis in 4 of 44 (9.1%) patients. Retinal reattachment was achieved in 40 of 44 (90.9%) patients; 14 of 44 (31.8%) patients underwent one or more additional procedures for recurrent detachment. Final visual acuity in the patients in this series was >/=20/40 in 8 of 44 (18%), 20/50 to 20/100 in 13 of 44 (30%), 20/200 to 5/200 in 13 of 44 (30%), and <5/200 in 10 of 44 (23%). In the 36 patients with vision less than 20/40, the primary causes of decreased vision were attributed to prior history of RD in 8 of 36 (22.2%), corneal edema in 7 of 36 (19.4%), cystoid macular edema in 5 of 36 (13.9%), persistent retinal detachment in 4/36 (11.1%), preexisting primary open-angle glaucoma in 4 of 36 (11.1%), age-related macular degeneration in 3 of 36 (8.3%), epiretinal membrane in 2 of 36 (5.5%), macular hole in 1 of 36 (2.7%), optic atrophy in 1 of 36 (2.7%), and irregular astigmatism in 1 of 36 (2.7%) patients.

CONCLUSIONS

RD is a frequent complication in eyes undergoing PPV for removal of retained lens fragments. Despite favorable retinal reattachment rates, visual acuity outcomes are often poor in these eyes and are associated with other comorbidities such as corneal edema and cystoid macular edema. Poor initial visual acuity and the presence of a retinal tear at the time of PPV were associated with a higher rate of RD after PPV.

Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification

PURPOSE

To report the rate of retinal detachment after vitrectomy for retained intravitreal lens material after phacoemulsification using specific vitrectomy techniques designed to minimize retinal detachment.

DESIGN

Consecutive, interventional case series.

METHODS

Retrospective chart review of 100 consecutive eyes (one surgeon) of 100 patients undergoing vitrectomy for retained lens material after phacoemulsification and followed up for 3 months or longer unless an outcome event had occurred. Vitrectomy techniques employed to minimize the frequency of retinal detachment included inducing posterior vitreous detachment with maximal vitreous removal before phacofragmentation to avoid vitreous trauma, lens fragment debulking before fragmentation, use of low energy with high aspiration during removal of retained lens material, and intraoperative indirect ophthalmoscopic evaluation of the retinal periphery with scleral indentation to diagnose and treat intraoperative retinal breaks. The main outcome measures included prevalence of coexisting retinal detachment in eyes with retained lens material, incidence of retinal detachment or retinal breaks after vitrectomy for removal of retained lens material, and final visual acuity.

RESULTS

The prevalence of previtrectomy retinal detachment was 4%; the incidence of postvitrectomy retinal detachment was 4%; the final visual acuity was 20/40 or better in 53%. One patient had a retinal break recognized during vitrectomy and was treated with retinocryopexy, but postoperative retinal detachment developed from a separate break. Three others were treated during vitrectomy for retinal breaks (including two with known preexisting breaks) and did not have any retinal detachment. Poor previtrectomy visual acuity (hand motions) was a risk factor for postvitrectomy retinal detachment.

CONCLUSIONS

The rate of retinal detachment reported after vitrectomy for retained lens material after phacoemulsification can be minimized to approximately the rate expected with cataract extraction complicated by vitreous loss by employing standard surgical techniques. Higher risk eyes may benefit from more frequent postvitrectomy examinations.