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RD after vitrectomy for lens fragments more common with poor preop vision

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MIAMI - Retinal detachment after pars plana vitrectomy for lens fragment removal occurs at a higher rate in eyes with poor initial visual acuity and previous retinal tears, researchers here have found.

Jeffrey K. Moore, MD, and colleagues at Bascom Palmer Eye Institute retrospectively reviewed the charts of all patients over 12 years who underwent pars plana vitrectomy (PPV) for retained lens material after cataract surgery.

In all, 343 patients underwent vitrectomy for retained lens material, 44 of which had retinal detachments (25 before or during PPV and 19 after). Retinal detachment (RD) was macula-on in half the patients. Giant retinal tears were the cause of the RD in seven patients, limited suprachoroidal hemorrhage caused three of the RDs, and endophthalmitis was the cause of four. Retinal reattachment was achieved in 40 patients; 14 patients required more than one surgery because of recurrent detachment.

Final visual acuity (VA) for most of the patients was poor, Dr. Moore wrote in the April issue of Ophthalmology. VA was greater than 20/40 in eight of the 44 patients and ranged from 20/50 to 20/100 in 13 patients, 20/200 to 5/200 in 13 patients and was worse than 5/200 in 10 patients.

For the 36 patients whose VA was worse than 20/40, the leading factors were a previous history of RD, corneal edema and cystoid macular edema.

“Strategies to prevent post-PPV RD include systematic intraoperative examination of the retinal periphery, especially in patients with poor presenting visual acuity and pre-existing retinal tears,” Dr. Moore wrote.

In a discussion of the study, Thomas Aaberg, Jr., MD, wrote that Dr. Moore presented “the largest consecutive series to date of retinal detachment after pars plana vitrectomy for retained lens fragments. This study can serve as a reference point for future work in this area.”