Prevention of lens opacification during diabetic vitrectomy

Lensectomy at the time of vitrectomy on diabetic patients markedly increases the risk of postoperative neovascular glaucoma, and is to be avoided when possible. We conducted a randomized prospective double-blind trial to determine if the addition of supplemental glucose to BSS Plus intraocular irrigating solution would lessen or prevent intraoperative lens opacification. Ten subjects received BSS Plus (glucose = 100 mg/dl); five (50%) developed intraoperative lens changes which interfered with the surgeon's view (three to an extent necessitating lensectomy). Ten subjects received glucose fortified BSS Plus (glucose = 400 mg/dl); none developed intraoperative lens changes (P less than 0.03, Mann-Whitney Rank). There was no statistically significant difference between the two study groups with respect to preoperative lens changes, infusion fluid volume, operative time, patient age, duration of diabetes, fasting blood glucose level, hemoglobin A1 level or lens clarity 5 months after surgery. We conclude that glucose fortification of BSS Plus significantly reduces intraoperative lens opacification during diabetic vitrectomy.