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Clinically significant corneal astigmatism and pars plana vitrectomy
M Madison Slusher1, Jerry G Ford, Brandon Busbee
1Wake Forest University Eye Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1033, USA.
Ophthalmic Surgery and Lasers
|February 1, 2002
Summary
Repeat pars plana vitrectomy (PPV) can cause visually disabling astigmatism, a rare complication. This wound-related issue, often seen after repeated procedures through the same incisions, can be effectively treated with suture lysis.
Area of Science:
- Ophthalmology
- Surgical Complications
- Corneal Astigmatism
Background:
- Pars plana vitrectomy (PPV) is a common ophthalmic procedure.
- Repeat PPV may be associated with unforeseen complications.
- Wound integrity after ocular surgery is crucial for visual outcomes.
Purpose of the Study:
- To identify and describe a rare wound-related complication following repeat pars plana vitrectomy (PPV) combined with anterior segment surgery.
- To investigate visually disabling astigmatism as a potential complication.
- To highlight an unappreciated risk in specific surgical scenarios.
Main Methods:
- Retrospective study of 135 patients undergoing PPV over 15 months.
- Identification of 7 patients with persistent, visually disabling astigmatism 3-4 months post-surgery.
- Objective documentation of astigmatism using videokeratoscopy.
Main Results:
- Seven patients developed visually disabling astigmatism (average 4.5 D) after repeat PPV.
- Astigmatism presented as a symmetric "bow-tie" pattern along the sclerotomy meridian.
- Suture lysis in 5 patients with repeat PPV through same sclerotomies reduced astigmatism to an average of 1.5 D.
Conclusions:
- Visually disabling astigmatism months post-surgery is a rare, wound-related complication of PPV.
- This complication is particularly noted in repeat procedures using the same sclerotomies.
- Videokeratoscopy is a reliable detection method, and suture lysis offers a simple corrective solution.