A 10-year review of the visual outcomes of early versus late pars plana vitrectomy in eyes with dropped lens fragment or nucleus during phacoemulsification

Abstract

Background: Pars plana vitrectomy (PPV) is a routine surgical option for the removal of dropped lens fragment or nucleus in the vitreous cavity due to complicated cataract surgery; however, its optimal timing is controversial. Therefore, we aimed to determine the visual outcomes of early versus late PPV in eyes with dropped lens fragment or nucleus due to complicated phacoemulsification cataract surgery.
 Methods: This descriptive-analytical retrospective study collected data of patients who underwent early (less than or equal to 1 week) versus late (> 1 week) PPV for the management of dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery over a 10-year period at Imam Khomeini Tertiary Referral Hospital, Ahvaz, Iran. Demographic characteristics, the interval between complicated phacoemulsification and PPV, pre- and postoperative intraocular pressures, best-corrected distance visual acuity (BCDVA), and postoperative complications were extracted from each patient’s record.
 Results: Fifty-one eyes of 51 patients with a mean (standard deviation [SD]) age of 64.66 (6.54) years and a male-to-female ratio of 33 (64.7%) to 18 (35.3%) were included over 10 years. The mean (SD) BCDVA before PPV was 1.87 (0.53) logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.54 (0.46) logMAR at the final postoperative visit (P < 0.001). The mean (SD) BCDVA was significantly better after early PPV than after late PPV (0.41 [0.30] versus 0.62 [0.52] logMAR; P < 0.05). There was no significant difference in the final BCDVAs among the three methods of lens fragment removal (P > 0.05). The rates of post-PPV complications were as follows: 29 (56.9%) eyes with corneal edema, 16 (31.4%) eyes with uveitis, 10 (19.6%) eyes with cystoid macular edema, 8 (15.7%) eyes with rhegmatogenous retinal detachment, and 8 (15.7%) eyes with other complications (optic nerve atrophy, choroidal neovascularization, vitreous hemorrhage, or epiretinal membrane formation). No significant differences were observed in the rates of complications according to the time interval between complicated phacoemulsification and PPV (all P > 0.05). The frequency of corneal edema was significantly higher when removing lens fragments using the trans-limbal method than using the other methods (P < 0.05), yet the rates of other complications were comparable among the three methods of lens fragment removal (all P > 0.05).
 Conclusions: Early PPV and removal of a dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery are recommended to achieve better visual outcomes. Future studies with longer follow-up, greater sample sizes, and analysis of other parameters of visual function, such as contrast sensitivity, visual field, color vision, and stereopsis, could provide more conclusive results and help verify our preliminary findings.