Anterior capsular contraction after cataract surgery in vitrectomized eyes.

PURPOSE: To assess the contraction of continuous curvilinear capsulorhexis after cataract surgery in eyes with past pars plana vitrectomy. METHODS: In a prospective study, 16 eyes of 16 patients underwent phacoemulsification and implantation of a foldable acrylic intraocular lens after pars plana vitrectomy. Eyes after intensive or repeated vitrectomy were not included. Twenty eyes of 19 patients served as age-matched controls. Aqueous flare intensity was measured using the laser flare-cell meter 1 year after surgery. The area of anterior capsular opening (ACO) was determined by diaphanoscopy using the anterior eye segment analysis system EAS-1000 at 1 day and 1 year postoperatively. RESULTS: There was no significant difference in the mean ACO area between the vitrectomy and control groups both at 1 day and 1 year postoperatively. Aqueous flare intensity 1 year after surgery was slightly higher in the vitrectomy group, but the difference was not statistically significant. CONCLUSION: Eyes after simple vitrectomy are not at a higher risk of ACO contraction following cataract surgery.     

硅油填充眼手法小切口与超声乳化白内障手术的并发症

目的：比较超声乳化联合硅油取出术与硅油填充眼手法小切口白内障手术(MSICS)的安全性。

方法：回顾性对比研究。162例患者162眼接受白内障手术,超声乳化联合硅油取出术与硅油填充眼手法小切口白内障手术均行玻璃体切除。

结果：超声乳化白内障手术组术后低眼压21眼(18.91%)MSICS组术后低眼压8眼(15.68%),两组间无明显统计学差异(P=0.666)。术后1mo两组间视网膜复位率无明显统计学意义; 超声乳化白内障手术组8例患者(7.2%)复发,硅油填充眼手法小切口白内障手术组9例(17.64%)复发,两组复发率比较,差异无统计学意义(P=0.055)。

结论：硅油填充眼手法小切口白内障手术相较于超声乳化联合硅取出术在低眼压、渗漏、脉络膜脱离、视网膜复位率方面结果无劣效性。     

Stabilization of anterior chamber depth during phacoemulsification cataract surgery in vitrectomized eyes

Abnormal fluctuations in anterior chamber (AC) depth including deepening and mydriasis with paradoxical shallowing and miosis have been described during phacoemulsification cataract surgery in previously vitrectomized eyes. Contributory factors include zonular laxity and reduction of vitreous volume. This report describes a technique to stabilize AC depth and allow safer sculpting and removal of lens matter.     

Microincision cataract surgery in a vitrectomized eye

Phacoemulsification after vitrectomy is associated with several intraoperative problems. We describe the use of bimanual microincision cataract surgery using an 18-gauge needle as the irrigating chopper combined with silicone oil removal in a vitrectomized eye. This technique may offer a safe alternative to standard phacoemulsification in such cases.     

Comparative study of femtosecond laser‐assisted cataract surgery and conventional phacoemulsification in vitrectomized eyes

Importance

To compare the safety and outcomes of femtosecond laser‐assisted cataract surgery (FLACS) and conventional phacoemulsification in post‐vitrectomy eyes.

Background

To compare visual outcomes and adverse outcomes of FLACS and conventional phacoemulsification in vitrectomized eyes.

Design

Single surgeon, retrospective study set in a private clinic in Auckland, New Zealand. Patients selected in a chronological manner, without masking or randomization.

Participants

Only patients undergoing cataract extraction following vitrectomy were included.

Methods

The last 25 surgeries performed prior to acquisition of the femtosecond laser and the first 25 surgeries performed following acquisition of the femtosecond laser were included. Patient demographic data, preoperative and postoperative visual acuities were collected. Intraoperative and postoperative complications were compared. Follow‐up ranged from 1 to 74 months.

Main Outcome Measures

The main outcome measures are postoperative visual outcomes and intra‐ and postoperative complications for both groups.

Results

Results of FLACS compared to conventional phacoemulsification are as follows: preoperative logMAR best corrected visual acuity (BCVA) (0.63 vs. 0.69), postoperative logMAR BCVA (0.17 vs. 0.19), posterior capsule complications (0% vs. 12%, P = 0.235), cystoid macular oedema (CMO) (12% vs. 20%, P = 0.705) and postoperative neodymium‐doped yttrium aluminium garnet (Nd:YAG) capsulotomy (16% vs. 48%, P = 0.032).

Conclusions and Relevance

FLACS demonstrates comparable visual outcomes to conventional phacoemulsification. Whilst outcomes measured were not statistically significant, except postoperative YAG capsulotomy, FLACS showed a trend towards a better intraoperative and postoperative safety profile. Femtosecond laser offers a theoretical advantage in reducing complication rates in post‐vitrectomy eyes, further larger studies are needed.     

Phacoemulsification on previously vitrectomized eyes: results of a 10-year-period

PURPOSE: To provide an overview of intraoperative and postoperative complications during phacoemulsification cataract surgery and to evaluate the visual results in patients having pars plana vitrectomy (PPV) with 10 years of follow-up. METHODS: Retrospective evaluation of intraoperative and postoperative complications and postoperative visual results in 134 consecutive patients who underwent phacoemulsification after PPV. Of 11,498 eyes treated with phacoemulsification, 143 (1.2%) had previous PPV during the 10-year period were included in this study. RESULTS: The phacoemulsification procedure seemed to be difficult where there was a deep or fluctuating anterior chamber (93%) and primary posterior capsule opacification (19%). The most frequent intraoperative complications were posterior capsule rupture (9%) and incomplete capsular rhexis (5%). Postoperative intraocular pressure elevation (7%), retinal detachment (6%), and posterior capsule opacification (8%) occurred most frequently during the mean follow-up period of 18.2 months (1.5-110 months). Best-corrected visual acuity (BCVA) increased two or more Snellen E lines in 55% of the cases or became better than or equal to 0.5 in 10% of the cases. CONCLUSIONS: Despite the well-known difficulties encountered in vitrectomized eyes such as zonular damage, increased mobility of the lens-iris diaphragm, and altered intraocular fluid dynamics, phacoemulsification proved to be a safe procedure in the hands of experienced surgeons.     

玻璃体灌注下白内障超声乳化人工晶状体植入术

目的探讨玻璃体切割术后的白内障患者行玻璃体灌注下的白内障超声乳化术特点、手术并发症和视力预后。方法对52例52只眼玻璃体切除术后白内障行玻璃体灌注下的白内障超声乳化术，观察记录术中情况、术中术后并发症和视力预后。结果2只眼在白内障超声乳化术中出现“灌注偏离综合症”，39只眼可见角膜后壁细小灰白色乳化硅油集聚并排出眼外。所有病例未出现巩膜塌陷、晶状体掉入玻璃体腔等术中并发症，11只眼术中发现后囊混浊机化，其中9只眼行后囊连续环行撕囊术并植入后房型人工晶状体，2例撕除全部后囊植入前房型人工晶状体。52只眼术后视力较术前提高，术后并发症少。结论对曾行硅油填充、虹膜后粘连、小瞳孔、多次手术后低眼压、怀疑晶状体损伤的复杂性玻璃体切割术后白内障患者在超声乳化术中应行玻璃体腔液体灌注以利手术操作和减少手术并发症，提高手术质量。     

Bevacizumab (Avastin) for diabetic macular edema in previously vitrectomized eyes

PURPOSE: To report the visual acuity (VA) and foveal thickness (FT) changes after intravitreal bevacizumab for diabetic macular edema (DME) in previously vitrectomized eyes. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: Medical records of 11 eyes of 10 patients who underwent intravitreal bevacizumab injection for persistent DME were reviewed. This retrospective study included eyes that had persistent DME despite prior pars plana vitrectomy with internal limiting membrane removal at our institution with optical coherence tomography (OCT) assessment of DME. All eyes received three intravitreal injections of bevacizumab 1.25 mg/0.05 ml monthly. RESULTS: Mean FT was 408 +/- 77 microm at baseline, 453 +/- 97 microm at three months, and 454 +/- 101 microm at six months (P = .172). Mean Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores were 59 +/- 15 (20/80) at baseline, 59 +/- 16 (20/80) at three months, 57 +/- 15 (20/80) at six months (P = .398). CONCLUSION: No change in VA and FT was observed in the short-term after intravitreal bevacizumab for DME in previously vitrectomized eyes.     

Suprachoroidal hemorrhage during cataract surgery in a vitrectomized eye

We report a case of surprachoroidal hemorrhage (SCH) that occurred during cataract surgery in a previously vitrectomized eye. The only sign of SCH was a progressive shadow obscuring the red reflex. There was no increase in intraocular pressure (IOP), shallowing of the anterior chamber, or iris prolapse. Postoperatively, the SCH gradually resolved without complications, leaving a series of subretinal pigmentary lines. Surgeons should be aware that the signs normally expected in SCH may not develop in vitrectomized eyes. Obscuration of the red reflex may be the only sign of the hemorrhage, and when this happens, it may be prudent to keep the IOP elevated and suture the incision at the end of the procedure.     

The course of diabetic retinopathy following cataract surgery in eyes previously treated by laser photocoagulation.

The course of diabetic retinopathy following extracapsular cataract extraction with posterior chamber lens implantation in eyes previously treated by laser photocoagulation for diabetic retinopathy was retrospectively studied in 33 eyes (33 patients). In 20 eyes (61%) there was no change in the retinal status postoperatively. In 13 (39%) there was postoperative progression of diabetic retinopathy compared with the fellow non-operated eye, in which progression occurred in nine eyes (27%). The severity of the preoperative status affected the incidence of progression. Four eyes (12%) developed complications of diabetic retinopathy--that is, rubeosis iridis and vitreous haemorrhage--which regressed after lasering. Cystoid macular oedema developed in 13 eyes (39%) and its incidence varied according to the postoperative course of diabetic retinopathy. The majority of the eyes showed a postoperative improvement in vision.     

Phacoemulsification in previously vitrectomized patients: an analysis of the surgical results in 100 eyes as well as the factors contributing to the cataract formation

PURPOSE: To evaluate the safety and effectiveness of phacoemulsification with clear corneal incision in previously vitrectomized patients as well as factors affecting the development time and type of cataract occurring after pars plana vitrectomy (PPV). METHODS: The authors conducted a prospective study of 100 consecutive eyes of patients who developed a cataract after PPV. Three groups were established based on the underlying vitreoretinal pathology. The main outcome measurements were intraoperative and postoperative complications and changes in best-corrected visual acuity (BCVA). RESULTS: The median interval between PPV and phacoemulsification was 11.5 months. Patients with proliferative diabetic retinopathy required phacoemulsification earlier (p=0.018). Posterior subcapsular cataracts developed more frequently in patients <50 years (73.7%, p=0.000) and affected those who underwent vitrectomy primarily for complicated retinal detachment (48.8%, p=0.046). Intraoperative complications included posterior capsular tears (4%), luxated nucleus into vitreous (2%), and zonular dialysis (5%). Postoperative complications were vitreous hemorrhage (6%), retinal redetachment (4%), pupillary synechiae (6%), ocular hypertension (4%), and Seidel phenomenon (3%). Posterior Nd:YAG laser capsulotomy was required in 44% of eyes. BCVA was improved in 85% of cases at the end of follow-up (median, 15.5 months). Twenty-one patients with one functioning eye (61.9%) demonstrated visual improvement compared with 79 patients with bilateral vision (91.1%; p=0.003). CONCLUSIONS: The technique allows stable improvement in BCVA through long follow-ups. It is more risky than in nonvitrectomized eyes. The visual results after phacoemulsification in vitrectomized eyes seem to be limited by retinal comorbidity and surgical complications.     

Phacoemulsification in vitrectomized eyes under topical anesthesia

PURPOSE: To study phacoemulsification in vitrectomized eyes under topical anesthesia, assessing anesthetic and intraoperative characteristics and complications. METHODS: A prospective study was performed on 52 eyes of 51 patients who underwent phacoemulsification of cataract with intraocular lens implantation under topical anesthesia, having previously undergone pars plana vitrectomy. Surgical and anesthetic observations and complications were recorded, as were visual outcomes. RESULTS: Ninety-two percent of patients had improved visual acuity postoperatively with only one patient having visual loss as a result of surgery. The most common intraoperative observations were of a deep anterior chamber, posterior capsular plaques, posterior synechiae, and nuclear sclerotic cataracts. Topical anesthesia proved satisfactory in 96%, with only two patients requiring intracameral lignocaine 1%; no patients required conversion to injection anesthesia. There were no major operative or postoperative complications. CONCLUSIONS: Phacoemulsification in vitrectomized eyes can be challenging, but is visually rewarding. Topical anesthesia proved satisfactory for the vast majority of cases, with none of our patients requiring conversion to injection anesthesia.     

白内障手术前要认识“高危”眼

某些眼在白内障手术中易发生并发症,存在手术高风险。在这些“高危”眼上作手术,术后低视力发生率高（术后最好矫正视力低于0．1）。