Visual results following vitreous loss and primary lens implantation

Abstract

Implantation of an intraocular lens following vitreous loss at cataract surgery is a controversial decision. To address this issue, we retrospectively identified all cases performed at the University of Minnesota in the last three years that had either a posterior or an anterior chamber lens placed following anterior vitrectomy. Twenty patients had a posterior chamber lens implant; 14 had follow-up longer than six months. All these patients achieved 20/40 or better visual acuity, although one patient had a retinal detachment. Of the six patients with an anterior chamber lens implant, four achieved 20/40 or better acuity and two achieved 20/50 acuity with follow-up of six months; one patient had a retinal detachment. This review demonstrates that with a meticulous anterior vitrectomy, good visual results can be achieved, although the risk of retinal detachment is higher than in uncomplicated cases.

Effects of posterior capsular disruption on the outcome of phacoemulsification surgery.

“…Not surprisingly, this study confirmed that capsular tears are more common than capsular dialyseswith incidences (25) Primary procedure -AC IOL implanted 4 (9) Primary procedureno IOL implanted 3 (7) Secondary procedure -AC IOL implanted 2 (5) AC IOL (total of primary and secondary procedures) 6 (14) PC=posterior chamber; AC=anterior chamber.…”

Visual acuity outcomes following vitreous loss in glaucoma and diabetic patients

“…[1][2][3][4][5] However, conflicting results are observed in the literature regarding the effect of vitreous loss and postoperative VA. Some studies show no significant difference in postoperative VA for surgeries complicated with and without vitreous loss, while others show a decrease in postoperative VA. [5][6][7] In this study, we observe that vitreous loss is a risk factor for decreased postoperative VA regardless of a vitrectomy.…”

“…This poorer vision could be due to a complication such as cystoid macular edema occurring as a result of an 'incomplete vitrectomy,' a procedure characterized by the unintentional retention of vitreous due to surgical error. 4,5 Also, it has been shown that excessive surgical manipulations cause more complications, which in turn can lead to a poorer visual prognosis. For example, when a vitrectomy has to be performed, the patient is immediately placed at risk for a lower postoperative VA. 1,6 The pre-existing pathology of glaucoma is known to complicate cataract procedures.…”

“…The occurrence of vitreous loss is associated with an increased frequency of retinal detachment, cystoid macular edema, corneal decompensation, and pseudophakic glaucoma, among other complications. [1][2][3][4][5] However, previous studies show conflicting results concerning the effect of vitreous loss on visual acuity (VA). Claoue and Steele showed a significant difference in VA between vitreous loss and non-vitreous loss patients during cataract surgery while Nishi and Bowbrow did not.…”

Vitreous loss in planned extracapsular cataract extraction does lead to a poorer visual outcome

“…Eighty-nine per cent achieved a VA of 20/40 or better; however, no analysis of subgroups or controls was presented. Spigelman et al 4 reported a 'favourable' visual outcome following vitreous loss but 20 out of their 26 cases were managed by PCL implants. The variation in these results is likely to be due to small case numbers and the different types of salvage procedure adopted.…”