Same-Day Versus Delayed Vitrectomy With Lensectomy for the Management of Retained Lens Fragments

Abstract

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.

Meta-analysis comparing same-day versus delayedvitrectomy clinical outcomes for intravitreal retained lens fragments after age-relatedcataract surgery

“…The analysis estimating each study’s power for comparing outcomes was updated, and the results (mean =24%, median =14%) again indicated that many studies had low power. Figure 2A shows whether SD-PPV or DEL-PPV seemed better for each outcome, for all articles with these data 2,3,6,7,11,12,14,15,17–19,22,24–27,29–31,34,35,40,43–45. These SD-PPV vs DEL-PPV results appear mixed and do not obviously favor either vitrectomy time.…”

“…Another statistical significance analysis, with studies separated into MCF+ (Figure 2B) and MCF− (Figure 2C), indicted that SD-PPV might have produced better outcomes in MCF+ studies2,7,11,17–19,22,24,25,27,30,32,35,40,44,45 but not in MCF− studies 3,6,12,14,15,26,29,31,34,43Table 3 compares the percent of SD-PPV and DEL-PPV patients with each outcome, by MCF policy status.…”

“…Several authors reported better VA and lower rates of complications (including retinal detachment, increased IOP, corneal edema, CME, and intraocular inflammation/infection) among patients who had SD-PPV compared with delayed vitrectomy (DEL-PPV), but these differences were not always statistically significant 25,29–31. Other authors reported little or no differences in these and other outcomes when comparing SD-PPV and DEL-PPV 32–34…”

Indications for surgical management of retained lens fragments

“…The impact of vitrectomy on the development of glaucoma is unclear. While some retrospective studies found that PPV within seven days of cataract surgery was associated with a decreased risk of developing glaucoma, others reported that the development of glaucoma did not appear to be influenced by the timing of vitrectomy [14]. Others have noted a trend toward higher rates of glaucoma in the early vitrectomy group, likely due to selection bias.…”

Current Medical and Surgical Management of Retained Lens Fragments After Cataract Extraction

“…15 Other studies are in agreement and did not find any relationship between the timing of vitrectomy and final visual outcome. 30,31,36,[47][48][49][50][51] However, some studies suggest that vitrectomy undertaken at the time of cataract surgery (if a vitreoretinal surgeon is available) or within 3 weeks, may improve overall visual outcome and reduce the risk for chronic elevation of intraocular pressure. [52][53][54] One systematic review and meta-analysis of retrospective interventional case series found optimal timing for vitrectomy in cases not requiring early PPV (i.e., in cases involving retinal detachment or endophthalmitis) to be between days 3 to 7 following cataract surgery.…”