Same-day vs. later PPV for retained lens fragments yields comparable results

Priscilla E. Perry Arnold, MD

This study by Modi et al is both powerful, in number of patients and design of study, and clinically important. Unfortunately, cataract surgeons will invariably experience the complication of retained lens fragments in their practice lifetime. This investigation has enhanced the decision-making process when such a complication does occur.

In a large retrospective review, the authors found that patients had similar outcomes of visual acuity and rates of complications whether pars plana vitrectomy was performed on the same day, at 1 week or after more than 1 week. Such information is particularly critical for the cataract surgeon who may not have easy access to same-day surgery and might be concerned that a few days’ delay would impact the outcome for the patient.

Caution is advised by referencing that “poorly controlled IOP, substantial intraocular inflammation, extensive media opacities or large posteriorly dislocated lens material may warrant earlier surgical intervention.” Also, the only outcome they suggested might benefit from earlier surgery was corneal edema, so that should be particularly considered in any patient with compromised corneal function preoperatively.

I believe the authors have given us a tool to improve our patient counseling and referral in a circumstance that is, by definition, a difficult time for all involved.

Reference:
Blodi BA, et al. Ophthalmology. 1992;doi:10.1016/S0161-6420(92)32003-2.