Immediate vitrectomy beneficial in patients with retained intravitreal crystalline lens fragments

April 6, 2008

An immediate vitrectomy should be considered in patients with retained intravitreal fragments of the crystalline lens after complicated cataract surgery. Eyes that underwent immediate vitrectomy had better visual acuity than eyes that underwent delayed vitrectomy, reported Michael Stewart, MD, of the Mayo Clinic, Jacksonville, FL.

An immediate vitrectomy should be considered in patients with retained intravitreal fragments of the crystalline lens after complicated cataract surgery. Eyes that underwent immediate vitrectomy had better visual acuity than eyes that underwent delayed vitrectomy, reported Michael Stewart, MD, of the Mayo Clinic, Jacksonville, FL.

An 8-year retrospective analysis performed at the Mayo Clinic of 6,676 cataract surgeries indicated that 0.48% of cases had retained crystalline lens fragments, Dr. Stewart said.

These cases were divided into those that underwent immediate (the same day as cataract surgery) vitrectomy and delayed (1 day or more after cataract surgery) vitrectomy. Those in the latter group had elevated IOP.

"The final results were good in both the immediate and delayed vitrectomy groups, but there were some differences worth discussing," Dr. Stewart said.

A total of 39 eyes (38 patients) were included. Five percent of the patients who underwent an immediate vitrectomy had a retinal detachment compared with 11% in the delayed vitrectomy group. All eyes had a final visual acuity of 20/41; 85% of the patients had a final visual acuity of 20/40 or better. The patients who underwent a delayed vitrectomy had an average visual acuity of 20/57 compared with those patients who underwent immediate vitrectomy who had a final visual acuity of 20/30; this difference reached significance (p = 0.03).

The development of secondary glaucoma did not appear to be influenced by the timing of vitrectomy.

Patients who underwent immediate vitrectomy had less subsequent visual field loss as measured by mean deviation and specific deviation compared with those who underwent delayed vitrectomy.

"We found that the immediate removal of lens fragments does appear to improve the final visual acuity," Dr. Steward said. "The immediate removal of lens fragments leads to a lower rate of retinal detachment compared with patients who underwent a later vitrectomy. Delayed removal of lens fragments did not lead to the development of secondary glaucoma, and immediate removal of lens fragments appears to improve the management of pre-existing glaucoma."