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Phacoemulsification for cataract following pars plana vitrectomy
M L McDermott1, J E Puklin, G W Abrams
1Kresge Eye Institute, Wayne State University, Detroit, MI 48201, USA.
Ophthalmic Surgery and Lasers
|July 1, 1997
Summary
Phacoemulsification after pars plana vitrectomy presents unique challenges, including a flaccid posterior capsule and altered anterior chamber dynamics. These technical aspects require careful management for successful cataract removal in vitrectomized eyes.
Area of Science:
- Ophthalmology
- Surgical Techniques
Background:
- Prior pars plana vitrectomy is often associated with complications of proliferative diabetic retinopathy.
- Nuclear sclerotic cataract is a predominant lens change in eyes with a history of vitrectomy.
Purpose of the Study:
- To compare the technical aspects of phacoemulsification for cataract removal in eyes with prior pars plana vitrectomy versus nonvitrectomized eyes.
- To identify specific surgical challenges encountered during phacoemulsification in vitrectomized eyes.
Main Methods:
- Retrospective review of 22 eyes that underwent cataract extraction after pars plana vitrectomy.
- Comparison with a cohort of 1039 consecutive cataract extractions in nonvitrectomized eyes by a single surgeon.
Main Results:
- Phacoemulsification in vitrectomized eyes exhibited deep anterior chambers and significant iris-lens diaphragm excursions.
- A flaccid and mobile posterior capsule was noted during lens cortex removal, without posterior capsule rupture.
- Postoperative visual acuity improved in 91% of patients who had undergone prior vitrectomy.
Conclusions:
- Phacoemulsification in eyes with prior vitrectomy is associated with challenges such as inadequate pupillary mydriasis and altered intraoperative dynamics.
- Excessively flaccid posterior capsules with plaques pose a risk during cataract removal.
- Specific surgical modifications may be necessary for phacoemulsification in the post-vitrectomy population.