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

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

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.

References

1. Chylack LT Jr, Wolfe JK, Singer DM, et al. The lens opacities abdominal system III. The longitudinal study of cataract study group. Arch Ophthalmol. 1993; 111:831–6.
2. Age-Related Eye Disease Study Research Group. The age-related eye disease study (AREDS) system for classifying cataracts from photographs: AREDS report no. 4. Am J Ophthalmol. 2001; 131:167–75.
3. Hall NF, Lempert P, Shier RP, et al. Grading nuclear cataract: abdominal and validity of a new method. Br J Ophthalmol. 1999; 83:1159–63.
4. Margherio RR, Cox MS Jr, Trese MT, et al. Removal of epimacular membranes. Ophthalmology. 1985; 92:1075–83.
crossref
5. Cherfan GM, Michels RG, de Bustros S, et al. Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes abdominal macular pucker. Am J Ophthalmol. 1991; 111:434–8.
6. Ogura Y, Takanashi T, Ishigooka H, Ogino N. Quantitative analysis of lens changes after vitrectomy by fluorophotometry. Am J Ophthalmol. 1991; 111:179–83.
crossref
7. Melberg NS, Thomas MA. Nuclear sclerotic cataract after abdominal in patients younger than 50 years of age. Ophthalmology. 1995; 102:1466–71.
8. Hsuan JD, Brown NA, Bron AJ, et al. Posterior subcapsular and nuclear cataract after vitrectomy. J Cataract Refract Surg. 2001; 27:437–44.
crossref
9. Thompson JT. The role of patient age and intraocular gas use in abdominal progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol. 2004; 137:250–7.
10. Michael R. Development and repair of cataract induced by abdominal radiation. Ophthalmic Res. 2000; 32(Suppl 1):ii–iii. 1–44.
11. Tranos PG, Peter NM, Nath R, et al. Macular hole surgery without prone positioning. Eye (Lond). 2007; 21:802–6.
crossref
12. de Bustros S, Thompson JT, Michels RG, et al. Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes. Am J Ophthalmol. 1988; 105:160–4.
crossref
13. Gupta D. Face-down posturing after macular hole surgery: a review. Retina. 2009; 29:430–43.
14. Hasegawa Y, Hata Y, Mochizuki Y, et al. Equivalent tamponade by room air as compared with SF(6) after macular hole surgery. Graefes Arch Clin Exp Ophthalmol. 2009; 247:1455–9.
crossref
15. Kim SS, Smiddy WE, Feuer WJ, Shi W. Outcomes of sulfur abdominal (SF6) versus perfluoropropane (C3F8) gas tamponade for macular hole surgery. Retina. 2008; 28:1408–15.
16. Kirwan JF, Venter L, Stulting AA, Murdoch IE. LOCS III examination at the slit lamp, do settings matter? Ophthalmic Epidemiol. 2003; 10:259–66.
crossref
17. Tan AC, Loon SC, Choi H, Thean L. Lens Opacities Classification System III: cataract grading variability between junior and senior staff at a Singapore hospital. J Cataract Refract Surg. 2008; 34:1948–52.
crossref
18. Grewal DS, Brar GS, Grewal SP. Correlation of nuclear cataract lens density using Scheimpflug images with Lens Opacities Classification System III and visual function. Ophthalmology. 2009; 116:1436–43.
crossref
19. Magalhães FP, Costa EF, Cariello AJ, et al. Comparative analysis of the nuclear lens opalescence by the Lens Opacities Classification System III with nuclear density values provided by Oculus Pentacam: a cross-section study using Pentacam Nucleus Staging software. Arq Bras Oftalmol. 2011; 74:110–3.
crossref
20. Briand S, Chalifoux E, Tourville E, et al. Prospective randomized trial: outcomes of SF₆ versus C₃ F₈ in macular hole surgery. Can J Ophthalmol. 2015; 50:95–100.
21. Petermeier K, Szurman P, Bartz-Schmidt UK, Gekeler F. Pathophysiology of cataract formation after vitrectomy. Klin Monbl Augenheilkd. 2010; 227:175–80.

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.
jkos-57-1745f1.tif
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.
jkos-57-1745f2.tif
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.

TOOLS
Similar articles