Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

Jayoung Ahn; Che Ron Kim; Mingui Kong; Yong Seop Han; In Young Chung; Jong Moon Park

doi:10.3341/JKOS.2016.57.11.1745

Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010452

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Ahn, Kim, Kong, Han, Chung, and Park: Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

Original Article

J Korean Ophthalmol Soc 2016;57(11):1745-1751.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1745

Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

Jayoung Ahn, MD¹, Che Ron Kim, MD¹, Mingui Kong, MD^1,², Yong Seop Han, MD, PhD^1,², In Young Chung, MD, PhD^1,², Jong Moon Park, MD, PhD^1,^2,³

¹Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea

³Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea

Address reprint requests to Jong Moon Park, MD, PhD Department of Ophthalmology, Gyeongsang National University Changwon Hospital, #11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Korea Tel: 82-55-214-3850, Fax: 82-55-758-4158 E-mail: parkjm@gnu.ac.kr

Received 7 July 2016 Revised 13 August 2016 Accepted 20 October 2016

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 investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole.

Methods

All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF₆ gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam^® scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery.

Results

Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF₆ gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003).

Conclusions

After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.

Keywords: Cataract change, F/A exchange, Pentacam scheimpflug image, SF₆ gas injection, Vitrectomy

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Figure 1.

Scheimpflug image of lens exported to ImageJ software for measuring the nuclear density in the region of interest. (A) Scheimpflug image on pentacam of preoperative cataract. (B) Same patient Scheimpflug image on pentacam of 12 months postoperative cataract.

Figure 2.

Comparison of average cataract change between study eye and control eye over time. Figure (A-D) show average cataract change after vitrectomy of group 1. Figure (E-H) show average cataract change after vitrectomy of group 2. Cataract change was more rapid in study eyes than control eyes. Preop = preoperation; M = month(s). ^* p ＜ 0.05 compared with fellow eye.

Table 1.

Demographics

	Group 1	Group 2	p-value
Age (years)	65.1 ± 6.3	64.7 ± 6.5	0.846
Sex (male:female)	6:15	7:12	0.577
Preop VA (BCVA)
Study eyes	0.41 ± 0.12	0.37 ± 0.10	0.277
Control eyes	0.02 ± 0.04	0.03 ± 0.04	0.714
Postop 12 months VA (BCVA)
Study eyes	0.39 ± 0.14	0.35 ± 0.11	0.394
Control eyes	0.03 ± 0.05	0.04 ± 0.05	0.744
Operation time (minutes)	36.25 ± 5.8	37.12 ± 4.9	0.624
Diagnosis			0.462
ERM	12	6
MH	9	13

Values are presented as mean ± SD unless otherwise indicated. Preop = preoperation; VA = visual acuity; BCVA = best corrected visual acuity; Postop = postperation; ERM = epiretinal membrane; MH = macular hole.

Table 2.

Comparisons of cataract progression rate according to the kinds of injected gases

	Group 1	Group 2	p-value
Pentacam (mean)
1 month	6.4 ± 6.7	7.1 ± 4.9	0.700
2 months	11.6 ± 6.2	17.5 ± 12.4	0.059
4 months	20.0 ± 10.3	33.5 ± 14.0	0.001^*
6 months	34.8 ± 12.9	41.5 ± 14.0	0.126
12 months	47.0 ± 13.9	51.5 ± 16.7	0.355
Pentacam (max)
1 month	8.1 ± 6.9	12.7 ± 8.2	0.059
2 months	18.8 ± 9.9	28.1 ± 17.9	0.046^*
4 months	31.7 ± 18.9	51.8 ± 23.7	0.005^*
6 months	62.4 ± 27.3	68.2 ± 25.9	0.490
12 months	94.5 ± 31.8	94.0 ± 34.8	0.961
LOCS III
1 month	0.10 ± 0.30	0.16 ± 0.37	0.561
2 months	0.14 ± 0.36	0.53 ± 0.61	0.019^*
4 months	0.43 ± 0.60	1.00 ± 0.67	0.007^*
6 months	1.05 ± 0.67	1.26 ± 0.73	0.337
12 months	1.52 ± 0.81	1.58 ± 0.61	0.811
SE
1 month	–0.11 ± 0.29	–0.38 ± 0.42	0.022^*
2 months	–0.13 ± 0.28	–1.43 ± 0.85	0.000^*
4 months	–1.11 ± 0.62	–2.19 ± 1.00	0.000^*
6 months	–2.07 ± 0.74	–2.74 ± 0.97	0.019^*
12 months	–2.68 ± 0.98	–3.00 ± 0.93	0.297

Values are presented as mean ± SD unless otherwise indicated. Each value was a result of postoperative value minus preoperative value. SE = spherical equivalent.

^* Statistically significant p-value.

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