2020–2021 BCSC Basic and Clinical Science Course™
12 Retina and Vitreous
Part III: Selected Therapeutic Topics
Chapter 20: Vitreoretinal Surgery and Intravitreal Injections
Complications of Pars Plana Vitrectomy
Nuclear sclerotic cataract is the most common complication of vitrectomy. Within 3–6 months following vitrectomy, as many as 90% of phakic eyes in patients older than 50 years may develop visually significant nuclear sclerotic cataract. Vitrectomy may also increase the long-term risk of open-angle glaucoma. Both cataract progression and glaucoma are speculated to be the result of increased oxygen tension in the eye after vitrectomy, which in turn results in oxidative damage to the lens and trabecular meshwork, respectively.
Other complications of pars plana vitrectomy include intraoperative retinal tears (approximately 1%–5%), postoperative detachment (approximately 1%–2%), retention of subretinal perfluorocarbon liquid (when used), retinal and vitreous incarceration, endophthalmitis (approximately 0.05%), suprachoroidal hemorrhage and recurrent vitreous hemorrhage (approximately less than 1%; up to 5% and higher in diabetics). Endophthalmitis after vitrectomy is more common in patients with diabetes mellitus and in eyes with retained intraocular foreign bodies. Table 20-2 lists the most common complications of pars plana vitrectomy.
Banker AS, Freeman WR, Kim JW, Munguia D, Azen SP; Vitrectomy for Macular Hole Study Group. Vision-threatening complications of surgery for full-thickness macular holes. Ophthalmology. 1997;104(9):1442–1453.
Chang S. LXII Edward Jackson lecture: open angle glaucoma after vitrectomy. Am J Ophthalmol. 2006;141(6):1033–1043.
Thompson JT. The role of patient age and intraocular gases in cataract progression following vitrectomy for macular holes and epiretinal membranes. Trans Am Ophthalmol Soc. 2003; 101:485–498.
Table 20-2 Complications of Pars Plana Vitrectomy
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.