Vitreous incarceration complicating cataract surgery. A light and electron microscopic study

Area of Science:

• Ophthalmology
• Retinal Surgery
• Corneal Science

Background:

• Vitreous incarceration in cataract wounds is a known complication.
• It can lead to various ocular pathologies including aphakic cystoid macular edema, vitreoretinal traction, retinal detachment, and corneal decompensation.

Purpose of the Study:

• To investigate the postmortem corneal, anterior segment, and vitreoretinal changes in eyes with vitreous incarceration in the cataract wound.
• To report the incidence and characteristics of associated ocular pathologies.

Main Methods:

• Postmortem examination of 31 eyes with vitreous incarceration in the cataract wound.
• Light and electron microscopy were used to analyze corneal endothelium migration, basement membrane production (descemetization), fibrous ingrowth, and iridovitreal synechiae.
• Incidence of cystoid macular edema, vitreoretinal traction, retinal tears, retinal detachment, and preretinal membranes were documented.

Main Results:

• Fibrous ingrowth was observed in 84% of eyes, and iridovitreal synechiae in 87%.
• Cystoid macular edema occurred in 19% of eyes, often associated with retinal phlebitis and pars plicata distortion.
• Vitreoretinal traction (13%), retinal tears (6%), and retinal detachment (3%) were also noted. Preretinal membranes were present in 16% of eyes.

Conclusions:

• Vitreous incarceration in cataract wounds can result in significant ocular pathology.
• Persistent cystoid macular edema is a potential complication in a minority of affected eyes.
• Surgical intervention, such as vitrectomy, should include excision of vitreous from the wound, iris, and anterior vitreous cavity.