Increased risk of complications in postvitrectomy cataract surgery

This study analyzes the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy (PPV).

Study design

Researchers retrospectively studied eyes that underwent phacoemulsification between 2005 and 2015 at 8 sites in the United Kingdom. After excluding eyes with multiple intraocular surgeries, known risk factors for cataract progression or intraoperative complications with cataract surgery, the researchers compared outcomes and complications in 2,221 previously vitrectomized eyes versus 136,533 non-vitrectomized eyes. 

Outcomes

The rates of posterior capsule rupture were similar in the vitrectomized (1.5%) and non-vitrectomized (1.7%) groups. However, the vitrectomized group had a higher incidence of zonular dialysis (1.3% vs. 0.6%) and dropped nuclear fragment (0.6% vs. 0.2%) than the non-vitrectomized group.

Patients in the previously vitrectomized group had worse preoperative vision (0.96 vs. 0.62logMAR), were younger, and had longer axial lengths than individuals in the non-vitrectomized group. The visual acuity after cataract surgery was worse in the vitrectomized group (logMAR 0.41 vs. 0.17 logMAR in the non-vitrectomized group) after 4 to 12 weeks of follow up.

Limitations

This large, multicenter, retrospective study found elevated rates of zonular dialysis and dropped lens fragment during phacoemulsification after vitrectomy surgery. Although the study found visual acuity differences between the two groups, this finding may be due to the underlying pathology that precipitated the vitrectomy (e.g., retinal detachment) and the inclusion of both uncorrected and corrected visual acuity data.

Clinical significance

This study demonstrates the importance of counseling patients who undergo cataract surgery after vitrectomy about their increased risk of complications.