Management of complications after cataract surgery by the pars plana approach

Various ocular complications following cataract surgery were treated using vitrectomy instruments by the pars plana approach. A total of 11 eyes were operated. Eight of these eyes had various anterior segment problems: Secondary cataract (2 eyes), cyclitic pupillary membranes (2 eyes), up-drawn pupils (3 eyes), and occluding pupillary membrane following haemorrhage (1 eye). In 2 of these eyes opacities in the posterior vitreous were present as well. In addition, pars plana vitrectomy was performed in 3 eyes with presumed bacterial endophthalmitis. In one of these eyes, the vitreous was sterile at the time of the vitrectomy. The vitreous of the 2 other eyes contained Staphylococcus epidermidis, and Staphylococcus aureus, respectively. In the eyes with anterior segment problems, clear optical media were obtained in all cases. The visual outcome in these patients was determined by the condition of the retina at the time of surgery. Two of the eyes with endophthalmitis were saved with some preservation of vision. The third of these eyes which suffered from endopthalmitis caused by penicillinase-producing Staphylococcus aureus, was lost. In this case vitrectomy and adequate antibiotic therapy was delayed. The modern vitrectomy instruments designed for pars plana vitrectomies are highly suitable for management of anterior segment problems following cataract surgery. When these problems are combined with pathology of the posterior vitreous, both kinds of problems may be dealt with at the same operation. In cases of presumed bacterial endophthalmitis, early vitrectomy should be considered to remove infective organisms, to obtain a definite diagnosis, and at the same time the eye may be perfused with antibiotics.