Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments.

PURPOSE: To evaluate whether performing same-day pars plana vitrectomy versus delayed pars plana vitrectomy affects visual outcomes and ocular morbidity of patients with retained lens fragments after a complicated cataract surgery. METHODS: Retrospective, comparative case series of 172 eyes of 171 patients with retained lens fragments undergoing 3-port pars plana vitrectomy using 20-, 23-, or 25-gauge instrumentation between 2005 and 2008. Outcome measures included best-corrected visual acuity at 6 months, final best-corrected visual acuity, and postoperative complications such as cystoid macular edema, intraocular pressure elevation, retinal detachment, vitreous hemorrhage, choroidal hemorrhage, and endophthalmitis. RESULTS: The median age was 75 ± 0.8 years. The mean time to vitrectomy for the delayed group was 15 ± 2 days. The preoperative logarithm of the minimum angle of resolution best-corrected visual acuity for immediate vitrectomy was 0.73 ± 0.09 versus 0.72 ± 0.06 for delayed vitrectomy. Six-month logarithm of the minimum angle of resolution acuity was 0.44 ± 0.09 for same-day vitrectomy compared with 0.44 ± 0.05 for delayed vitrectomy (P = 0.97, 2-tailed t-test). Of 59 eyes undergoing immediate vitrectomy, 17 (29%) experienced postoperative complications, while 38 of 113 eyes (34%), experienced complications if undergoing delayed vitrectomy (Fisher exact test, P = 0.61). Overall, the most common complication was cystoid macular edema occurring in 25 of 172 eyes (15%). CONCLUSION: The outcomes of same-day pars plana vitrectomy appear to be similar to non-same-day pars plana vitrectomy. The risks and benefits related to the timing of vitrectomy after a complicated cataract surgery should be carefully discussed with each patient. Further investigation is warranted to establish an optimal time for surgical planning.

Incidence and characteristics of macular pucker formation after primary retinal detachment repair by pars plana vitrectomy alone.

PURPOSE: To evaluate postoperative macular pucker formation in patients who underwent pars plana vitrectomy (PPV) for repair of primary rhegmatogenous retinal detachment (RD). METHODS: A retrospective, observational case series of 141 consecutive patients who underwent primary RD repair by PPV alone was performed. Patient charts were selected based on coding searches of a database from May 1, 2002, to December 31, 2003, in a large retina referral practice. Patients with a history of retinal surgery, silicone oil tamponade, or another visually significant ocular condition were excluded. RESULTS: Of 141 patients, 18 (12.8%) were noted to have a postoperative epiretinal membrane at clinical examination. Of 18 patients, 6 (33.3%) underwent a second vitrectomy procedure with membrane peeling for macular pucker removal. The mean time from RD surgery to membrane peeling surgery was 5.4 months. The average improvement in vision after repeated surgery was 5.6 Snellen chart lines. CONCLUSIONS: In our series, 12.8% of patients who underwent repair of a primary RD by PPV alone developed a postoperative macular pucker. Overall, the 4.3% of patients who underwent repeated surgery for removal of macular epiretinal membranes benefited with visual acuity improvement.