The Changes of Anterior Chamber Depth, Axial Length, Refractive Errors after Combined Vitrectomy

Seo Sam; Cheol Seong Min; Woong Lim Han; Ho Kang Min; Yoon Cho Hee

doi:10.3341/jkos.2013.54.7.1032

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Sam, Min, Han, Min, and Hee: The Changes of Anterior Chamber Depth, Axial Length, Refractive Errors after Combined Vitrectomy

Original Article

J Korean Ophthalmol Soc 2013;54(7):1032-1037.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1032

The Changes of Anterior Chamber Depth, Axial Length, Refractive Errors after Combined Vitrectomy

Seo Sam, MD, Cheol Seong Min, MD, Woong Lim Han, MD, Ho Kang Min, MD, Yoon Cho Hee, MD

¹Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea

Address reprint requests to Min Cheol Seong, MD Department of Ophthalmology, Hanyang University Guri Hospital, #153 Gyeongchun-ro, Guri 471-701, Korea Tel: 82-31-560-2350, Fax: 82-31-561-9479 E-mail: goddns76@hanmail.net

Received 8 December 201229 January 2013 Accepted 22 April 2013

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 evaluate the changes of anterior chamber depth (ACD), Axial length (AXL) after combined vitrectomy and cat-aract surgery and to analyze the association with refractive errors.

Methods

In 22 eyes who underwent combined vitrectomy and cataract surgery (PPV-Phaco group), 20 eyes who under-went vitrectomy-only (PPV-only group) and 28 eyes who underwent uncomplicated cataract surgery (Phaco-only group), ACD and AXL were measured with IOL master (Carl Zeiss Jena, Germany) preoperatively and 3 months postoperatively. We compared the preoperative desired refraction and postoperative 3 months refraction.

Results

ACD were increased in PPV-Phaco group and Phaco-only group (all, p < 0.001) and this change was more prom-inent in PPV-Phaco group ( p = 0.030). In PPV only group, ACD was decreased ( p < 0.001). The AXL after surgery was not significant different from the preoperative AXL in PPV-Phaco and PPV only groups ( p = 0.612, p = 0.090). But the AXL was decreased in Phaco-only group ( p = 0.022). Hyperopic shifting were noticed in PPV-Phaco and phaco-only groups, but my-opic shifting was noticed in PPV-only group. However, these changes were not statistically significant ( p = 0.292, p = 0.251, p = 0.068).

Conclusions

ACD was increased after combined vitrectomy and cataract surgery. AXL was not changed. The hyperopic shifting was noticed after combined vitrectomy and cataract surgery, but was not statistically significant.

Keywords: Anterior chamber depth, Axial length, Combined vitrectomy, Refraction

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Figure 1.

(A) A diagram representing a normal anatomy of the eye. (B) After phacoemulsification, anterior chamber depth deepening effect caused by IOL replacement. (C) After com-bined vitrectomy, anterior chamber depth deepening by IOL replacement and decrease positive vitreous pressure. (D) After vitrectomy, decrease of adherence between zonule and vitre-ous makes zonule loose. Lens moves toward anterior chamber.

Table 1.

Clinical features of enrolled pati ents

Parameter		Group		p-value
Parameter	PPV-Phaco (n = 22)	PPV-only (n = 20)	Phaco-only (n = 28)	p-value
Age (year)	62.54 ± 9.74	49.14 ± 12.67	66.21 ± 10.87	<0.001^*
Gender (Male, %)	45.5%	60%	25%	0.129
Indication (n)
Vitreous hemorrhage (PDR)	12	10
Vitreous opacity (uveitis)	2	2
Epiretinal membrane	8	7
Terson’s syndrome		1

Values are presented as mean ± SD. PPV = pars plana vitrectomy; Phaco = phacoemulsification and intraocular lens implantation; PDR = proliferative diabetic retinopathy.

^* PPV-only vs Phaco-only : p < 0.001, PPV-only vs PPV-Phaco : p = 0.001, PPV-Phaco vs Phaco-only : p = 0.104.

Table 2.

Comparison of changes in anterior chamber depth and axial length following PPV-Phaco, vitrectomy-only and Phacoemulsification-only

Parameter			Group		p-value^†
Parameter	PPV-Phaco (n = 22)	PPV-only (n = 20)	Phaco-only (n = 28)		p-value^†
ACD (mm)
	Preoperative	3.08 ± 0.40	3.30 ± 0.47	3.10 ± 0.38	0.113
	Postoperative	4.64 ± 0.63	3.23 ± 0.46	3.99 ± 0.73	<0.001^‡
	Changes	1.56 ± 0.72	-0.07 ± 0.07	0.88 ± 0.61	<0.001^§
	p-value^*	<0.001	<0.001	<0.001
AXL (mm)
	Preoperative	23.05 ± 0.84	23.27 ± 1.14	23.88 ± 2.00	0.466
	Postoperative	23.02 ± 0.85	23.38 ± 1.11	23.77 ± 2.02	0.398
	Changes	-0.03 ± 0.27	0.11 ± 0.29	-0.11 ± 0.24	<0.001^Π
	p-value^*	0.612	0.090	0.022
Refraction
	Target (preoperative)	-0.44 ± 0.40	(-0.46 ± 0.35)	-0.76 ± 0.84	0.493
	Postoperative	-0.37 ± 0.34	-0.64 ± 0.43	-0.70 ± 0.82	0.159
	Changes	0.07 ± 0.31	-0.19 ± 0.45	0.06 ± 0.27	0.032^#
	p-value^*	0.292	0.068	0.251

Values are presented as mean ± SD. PPV = pars plana vitrectomy; Phaco = phacoemulsification and intraocular lens implantation; ACD = anterior chamber depth; AXL = axial length.

^* Paired t-test,

^† Kruskal-wallis

^‡ PPV-only VS Phaco-only : p = 0.001, PPV-only VS PPV-Phaco: p < 0.001, PPV-Phaco vs Phaco-only: p = 0.030

^§ PPV-only VS Phaco-only : p < 0.001, PPV-only VS PPV-Phaco: p < 0.001, PPV-Phaco vs Phaco-only: p = 0.001

^Π PPV-only VS Phaco-only : p < 0.001, PPV-only VS PPV-Phaco: p < 0.001, PPV-Phaco vs Phaco-only: p = 0.368

^# PPV-only VS Phaco-only : p = 0.012, PPV-only VS PPV-Phaco: p = 0.041, PPV-Phaco vs Phaco-only: p = 0.860.

Table 3.

Distributions of refractive errors after combined vitrectomy and cataract surgery

Parameter		Refractive prediction error (D)^*
Parameter	-1.0 to -0.5	-0.5 to 0.5	0.5 to 1.0
Combined vitrectomy (%)	13.6	68.2	18.2
Cataract surgery (%)	14.3	71.4	14.3

^* Actual minus predicted SE.

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