Risk of Complications of Vitrectomy for Floaters Based on Attached or Detached Status of Posterior Hyaloid Face

Abstract

Purpose: To ascertain whether posterior hyaloid face (PHF) status (attached vs detached) affects the risk of intraoperative retinal breaks and number of operations in patients undergoing vitrectomy for floaters. Methods: Consecutive, comparative single-surgeon case series. All patients undergoing vitrectomy for visually disabling floaters between July 2003 and June 2016 were included in this study. Data were collected prospectively into a vitreoretinal database and reviewed retrospectively for the purpose of the study.The following data were collected on each patient: age in years, sex, axial length (mm), presence of myopia, pre- and postoperative visual acuity in logarithm of the minimal angle of resolution. The status of the PHF was ascertained using preoperative clinical and optical coherence tomography assessment that was confirmed intraoperatively. The presence or absence of a retinal break was considered the primary outcome measure. Significant visual loss (reduction in ≥2 log units visual acuity), number of operations, and time from surgery to discharge were considered the secondary outcomes. Sequential multiple logistic and Cox regression analyses were conducted. Results: Data were collected from 97 patients (55 males and 42 females). Indications for surgery were Fuchs heterochromic cyclitis (9 patients), asteroid hyalosis (12 patients), and vitreous syneresis (76 patients). Twenty-one patients were pseudophakic on presentation, while 76 underwent combined phacovitrectomy. Vitreous status was significantly associated with retinal breaks ( P = .010). Controlling for other parameters, the odds of a retinal break in patients with PHF attached were about 5.5 times those in patients with PHF detached (95% confidence interval [CI], 1.52 -20.4). Number of operations was also significantly associated with this outcome ( P = .027); the odds of a retinal break increase by 6.28 times (95% CI, 1.23 -32.1). A substantive difference in the proportion of patients with retinal breaks was observed between the 2 groups, with a 50% prevalence rate in the attached group and a 9.1% prevalence rate in the detached group. Vitreous status was not associated with either secondary outcome measures. Number of operations was also significantly associated with time to discharge ( P = .008; hazard ratio, 2.78; 95% CI, 1.30 -5.91) in a multiple Cox model. Hence an increasing number of operations is associated with longer time to discharge. Conclusion: The analysis has found evidence to link vitreous status with the primary outcome of the presence of a retinal break. Particular care should be taken in, cases with vitreous attached status, to prevent missed breaks and subsequent rhegmatogenous retinal detachment.