AUG 05, 2010
The authors conducted this study to assess the prognosis and complications after pars plana vitrectomy (PPV) combined with lensectomy as a primary procedure for complicated cataract. This study demonstrates good results with lensectomy. However, I think this is a valid technique only for totally dislocated lenses, best used when Cionni surgery is unavailable or inappropriate due to total dislocation.
The authors retrospectively reviewed data from a study group of 40 patients (46 eyes) who underwent PPV combined with lensectomy as a primary procedure for complicated cataract without severe posterior segment pathology. Twenty-three of these eyes had traumatic lens dislocation, 12 had Marfan syndrome, seven had idiopathic lens dislocation and four had pseudoexfoliation syndrome. Their results were compared with a control group of 42 patients (43 eyes) who underwent combined PPV and lensectomy for uncomplicated cataract.
Median corrected distance visual acuity in the study group improved from 20/185 (range 20/20 to hand motions) preoperatively to 20/30 (range 20/20 to hand motions) three months postoperatively (P < 0.001). Postoperative corrected distance visual acuity was poorer in cases with an etiology of trauma (P = 0.018). Complications included retinal detachment (6.5 percent), transient vitreous hemorrhage (13.0 percent), choroidal detachment (4.3 percent) and cystoid macular edema (13.0 percent), which occurred more frequently in eyes with a history of trauma (P = 0.022). The retinal detachment rate was 17.0 percent among eyes with Marfan syndrome, compared with 2.9 percent among other eyes in the study group (P = 0.162). There was one retinal detachment (2.3 percent) in the control group.
The authors conclude that PPV with lensectomy yielded favorable visual outcomes in eyes with complicated cataract in which standard anterior segment techniques were prohibitive or risky. However, pre-existing conditions and postoperative complications may limit visual outcomes.
For partially dislocated lenses, especially in Marfan syndrome patients, I prefer an anterior approach to cataract removal in experienced hands. With the use of capsule suspension hooks and Cionni-modified capsular tension rings, it's rare to break the anterior hyaloids in Marfan patients no matter how subluxated the lens. Leaving a two-chambered eye is certainly preferable with regard to the risk of retinal detachment.
Where there is already vitreous prolapsed, making a pars plana incision for anterior vitrectomy and compartmentalizing with OVD can lead to excellent results. This leaves a two-chambered eye with a stable implant and is the best approach, in my opinion.