SEP 30, 2011
Cataract/Anterior Segment, Comprehensive Ophthalmology, Retina/Vitreous
Although no consensus exists on optimal vitrectomy timing for retained lens fragments, clinical guidelines generally favor early vitrectomy within one to two weeks. The findings of this meta-analysis and systematic review support those guidelines, with the best results found between days three and seven after cataract surgery.
This article is music to my ears. I think there are many areas in medicine where the convenient thing becomes the standard of care. I have always felt that the sooner significant retained nucleus is removed the better, but this is the first article that states it plainly enough to strongly request this of our referral retinal surgeons.
The authors analyzed 43 studies to evaluate the impact of pars plana vitrectomy timing on outcomes in patients who underwent surgery for retained lens fragments.
They found significantly better outcomes in terms of visual acuity, retinal detachment, increased IOP and intraocular infection/inflammation when vitrectomy was performed within the first week after cataract surgery.
One issue is whether or not to perform a vitrectomy on the same day as the cataract surgery. The authors found that some facilities had good same-day vitrectomy visual results, while others were not as good. Reasons for this dichotomy were unclear, and further studies are necessary.
The authors found that vitrectomy performed within two days of cataract surgery produced inferior outcomes compared with days three to seven. They weren't sure why this is the case but speculated that there is a window of time between the eye's recovery from cataract surgery and advanced immunologic response to macrophage-related inflammation.
They conclude that performing vitrectomy between three and seven days after cataract surgery may yield better patient outcomes. However, several variables must be in place for vitreoretinal surgeons to adopt this strategy: 1) corneal edema must have sufficiently cleared to allow unimpeded visualization of the vitreous and retina, 2) the patient must not have developed a complication (e.g., endophthalmitis or early retinal detachment) that required an immediate vitrectomy before day three, and 3) the cataract surgeon must have referred the patient in a timely manner to a vitreoretinal surgeon for evaluation.