Vitrectomy of any gauge may advance nuclear sclerotic cataract

Vitrectomy surgery using any gauge of instrumentation may result in significant progression of nuclear sclerotic cataract, a study found.

“This study indicates that the disruption and removal of the vitreous gel itself, and not the gauge of vitrectomy, is associated with the significant progression of nuclear sclerotic cataract,” the study authors said.

In the prospective, interventional, observational analysis, patients with various retinal conditions underwent Scheimpflug lens photography bilaterally at baseline, 6 months and 12 months postop. Eleven eyes received 20-gauge surgery, 22 had 23-gauge surgery and nine had 25-gauge surgery.

The small study could not detect differences in sclerotic progression between standard 20-gauge surgery and small-gauge surgery, the authors said, but all operated eyes demonstrated significant progression of nuclear sclerotic cataract compared with fellow, unoperated eyes.

Notably, patients with nonischemic retinal conditions, such as macular hole or premacular fibrosis, experienced the same progression regardless of instrumentation gauge.

“Vitrectomy surgery removes the vitreous gel responsible for protecting the lens from exposure to molecular oxygen within the eye. This leads to more rapid oxidative damage of the crystalline lens and thus promotes significant progression of nuclear sclerotic cataract,” the authors said.

 Study limitations included possible selection bias on the part of surgeons selecting a gauge, small sample size and the substantial number of patients lost to follow-up due to cataract extraction, the authors said.