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Kim, Kweon, Ahn, and Cho: Phacoemulsification in Previously Vitrectomized Eyes; Results of a 5-Year Period in Surgical Outcome
Original Article

J Korean Ophthalmol Soc 2009;50(7):1015-1021.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.7.1015

Phacoemulsification in Previously Vitrectomized Eyes; Results of a 5-Year Period in Surgical Outcome

Woo Jin Kim, MD, Eui Yong Kweon, MD, Min Ahn, MD, Nam Chun Cho, MD

Department of Ophthalmology, School of Medicine, Chonbuk National University, Jeonju, Korea

Address reprint requests to Eui Yong Kweon, MD Department of Ophthalmology, School of Medicine, Chonbuk National University #634-18 Geumam-dong, Dukjin-gu, Jeonju 561-712, Korea Tel: 82-63-250-1965, Fax: 82-63-250-1960, E-mail: key@chonbuk.ac.kr

Received 3 November 2008       Accepted 25 March 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the incidence of complications and the outcome of phacoemulsification surgery in patients with and without previous vitrectomy.

Methods

We retrospectively investigated 60 patients in a study group that received phacoemulsification with posterior chamber IOL implantation (PC-IOL) in the vitrectomized eye and 60 patients in a control group that received only phacoemulsification with PC-IOL implantation from January 2003 to December 2007. The interval from PPV to cataract extraction, sex, age, type of cataract, intraoperative and postoperative complications, pre- and postoperative refraction were reviewed.

Results

The most common indication of pars plana vitrectomy was diabetic retinopathy. Nucleosclerosis was the most common type of cataract. The most common intraoperative complication was posterior capsular rupture, but there was no statistical significance when compared with the control group (p=0.116). In addition, the most common postoperative complication was posterior capsular opacity. After phacoemulsification, the rate at which a BCVA of 0.5 or better was obtained was lower in the study group than the control group. The spread between actual and expected refraction showed no statistically significant difference when compared with the control group (p=0.309).

Conclusions

Experienced surgeons can safely perform phacoemulsification and PC-IOL implantation in previously vitrectomized eyes. However, the outcome of visual acuity is limited by vitreoretinal pathology that requires vitrectomy.

Keywords: Cataract, Pars plana vitrectomy, Phacoemulsification, Vitrectomized eye

References

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Figure 1.
Type of cataract in study and control group.
jkos-50-1015f1.tif
Figure 2.
Scattergram showing the relationship between logarithm of the minimum angle of resolution (LogMAR) visual acuity before and after phacoemulsification in eyes with previous pars plana vitrectomy (PPV) and without PPV.
jkos-50-1015f2.tif
Table 1.
Demographic of patients
Study group Control group p-value
Age (year) 61.4 63.967 0.144
Sex (M/F ratio) 25/35 (5:7) 25/35 (5:7) −
Interval from PPV* to vitrectomy (months) 19.23 − −
Follow up duration (months) 18.43±18.75 2.38±2.25 <0.001

* Pars plana vitrectomy.

Table 2.
Indication of vitrectomy
Indication Number of eyes (%)
Diabetic retinopathy 26 (43.3)
Retinal detachment 14 (23.3)
Vitreous hemorrhage 7 (11.7)
Epiretinal membrane 6 (10)
Macular hole 4 (6.7)
Acute retinal necrosis 3 (5.0)
Total 60
Table 3.
Type of cataract in study and control group
Study group (%) Control group (%) p-value
NS* 27 (45) 9 (15) <0.001
PSC† 10 (17) 1 (1.7) 0.004
Cortical 2 (3) 10 (17) 0.015
NS/PSC 9 (15) 3 (5) 0.382
Mixed‡ 12 (20) 37 (61.7) <0.001
Total 60 60 <0.001

* Nucleosclerosis

† Posterior subcapsular

‡ NS/cortical, PSC/cortical, NS/PSC/cortical

Table 4.
Intraoperative complications in study and control group
Study group (%) Control group (%) p-value
Small pupil 1 (1.7) 1 (1.7) 1
Posterior capsule plaque 2 (3.3) 1 (1.7) 0.559
Posterior synechia 1 (1.7) 1 (1.7) 1
Posterior capsule rupture 8 (13.3) 3 (5.0) 0.114
Dropped lens 1 (1.7) 0 (0) 0.315
Zonular weakness (dialysis) 3 (5.0) 1 (1.7) 0.309
Incomplete capsulohexis 0 (0) 1 (1.7) 0.315
Iris rupture 0 (0) 1 (1.7) 0.315
None 44 (73.33) 51 (85.0) 0.116
Total 60 60
Table 5.
Postoperative complications in study and control group
Study group (%) Control group (%) p-value
Corneal edema 2 (3.3) 3 (5.0) 0.648
Increasing IOP* 1 (1.7) 2 (3.3) 0.559
Posterior vitreal detachment 0 (0) 2 (3.3) 0.154
Posterior capsular opacity requiring 0 (0) 0 (0)
Nd:YAG capsulotomy 10 (16.7) 4 (6.7) 0.088
None 47 (78.3) 49 (81.7) 0.648
Total 60 60

* Intraocular pressure.

Table 6.
Visual acuity of pre-PE & post-PE in study and control group
Number of Patients (%) Study group (%) Control group (%) Chi-square p-value
Pre-PE* BCVA† 16.344 0.001
0.1 or worse 39 (65) 22 (36.7)
0.1 – 0.3 13 (21.7) 10 (16.7)
0.3 – 0.5 6 (10.0) 19 (31.7)
0.5 or better 2 (3.3) 9 (15.0)
Post-PE BCVA 28.988 <0.001
0.1 or worse 16 (26.7) 0 (0)
0.1 – 0.3 7 (11.7) 2 (3.3)
0.3 – 0.5 12 (20.0) 7 (11.7)
0.5 or better 25 (41.7) 51 (85)

* Phacoemulsification

† Best corrected visual acuity.

Table 7.
Change of visual acuity in study and control group
BCVA* Study group Control group p-value
Improved 48 56 0.032
No change 6 1 0.051
Worsened 6 3 0.298

* Best corrective visual acuity.

Table 8.
Analysis between BCVA 0.5 or better after PE and postulated risk factors
Predictor Variable Better than BCVA 0.5/ Total Eyes (%) Chi-square p-value
Prior vitrectomy 24.258 <0.001
Yes 25/60 (41.7)
No 51/60 (85)
Gender 0.647 0.270
Men 30/50 (60)
Women 47/70 (67)
Pre-PE* BCVA† 9.126 0.010
0.1 or worse 32/64 (49)
0.1 – 0.3 16/21 (76)
0.3 – 0.5 20/25 (80)
Intraoperative difficulties 4.354 0.038
Yes 6/15 (40)
No 71/105 (67.6)
Postoperative complications 0.161 0.489
Yes 7/10 (70)
No 70/110 (63.6)

* Phacoemulsification

† Best corrected visual acuity.

Table 9.
Odds ratio from multivariate logistic regression model
Variable Odds ratio 95% confidence interval p-value
No ppv* vs ppv 5.310 2.509–11.235 <0.001
Pre-PE† VA‡ <o.1 vs >o.1 2.813 1.325–5.970 0.007
No intraop Cx§ vs intraop Cx 2.230 0.746–6.669 0.151

* Pars plana vitrectomy

† Phacoemulsifciation

‡ Visaul acuity

§ Complication.

Table 10.
Actual postoperative refraction and spread (actual-expected) refraction in study and control group
Variable Study group Control group p-value
Actual postoperative refraction −0.57222 −0.0678 0.033
Spread between Actual-expected refraction −0.3970 (±1.0907) −0.1848 (±1.0412) 0.309
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