Vitreous Abnormalities Secondary to Surgery
Incarceration of vitreous in the wound during cataract or vitreous surgery can lead to many postoperative complications. Following cataract surgery with vitreous incarceration, there is increased risk of infectious endophthalmitis, epithelial ingrowth, hypotony, shallow anterior chamber, peripheral anterior synechiae, and secondary glaucoma. Incarcerated vitreous in the wound and iridovitreal adhesions may cause chronic ocular discomfort with inflammation, cystoid macular edema, and optic nerve head edema (Irvine-Gass syndrome). These complications may be reduced by disconnecting any vitreous from anterior adhesions and incarcerations through vitrectomy.
Retinal detachment can be caused by contraction of vitreous incarcerated in cataract or vitrectomy incisions. Such detachments may be rhegmatogenous or tractional and may require treatment with vitrectomy and/or scleral buckling surgery (see Chapter 20).
The risk of complications from vitreous loss during cataract surgery can be sharply reduced by careful anterior vitrectomy followed by meticulous closure of all wounds. For further discussion of the complications of cataract surgery and their management, see BCSC Section 11, Lens and Cataract. For information about postoperative endophthalmitis, see BCSC Section 9, Uveitis and Ocular Inflammation.
Harbour JW, Smiddy WE, Rubsamen PE, Murray TG, Davis JL, Flynn HW Jr. Pars plana vitrectomy for chronic pseudophakic cystoid macular edema. Am J Ophthalmol. 1995;120(3):302–307.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.