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Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection.

ABSTRACT: Purpose:Patients with chronic narrow angle glaucoma (CNAG) are at increased risk of developing aqueous misdirection (AM) following intraocular surgery. We present a retrospective case series on the use of posterior capsulorrhexis with core vitrectomy by an anterior approach (CAV) at the time of cataract extraction with or without glaucoma surgery as a prophylactic measure for the prevention of AM in CNAG. Methods:Retrospective case series of six phakic eyes in four patients with CNAG and other risk factors for AM who underwent posterior capsulorrhexis and CAV at the time of cataract surgery with or without glaucoma surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and post-operative complications. Results:Six eyes in four subjects underwent posterior capsulorrhexis with CAV at the time of cataract surgery. The case was combined with incisional glaucoma surgery in the five eyes with advanced visual field loss. The mean logMAR BCVA and IOP improved from 0.554?±?0.398 and 25.2?±?13?mmHg, respectively, at the pre-operative visit to 0.257?±?0.218 and 12.2?±?1.7?mmHg, respectively, at final follow-up. Both eyes with nanophthalmos developed non-appositional serous choroidals that resolved with atropine, but the left eye required additional treatment with synechiolysis, intraocular lens repositioning, limited AV and endocyclophotocoagulation. There were no permanent, vision-threatening complications. Conclusions and importance:CAV can be safely combined with cataract surgery and glaucoma surgery, and it may be an effective intervention in eyes with CNAG and other risk factors for AM as a prophylactic measure against the development of AM.

SUBMITTER: Thompson AC

PROVIDER: S-EPMC6105756 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection.

Thompson Atalie C AC Challa Pratap P

American journal of ophthalmology case reports 20180813

<h4>Purpose</h4>Patients with chronic narrow angle glaucoma (CNAG) are at increased risk of developing aqueous misdirection (AM) following intraocular surgery. We present a retrospective case series on the use of posterior capsulorrhexis with core vitrectomy by an anterior approach (CAV) at the time of cataract extraction with or without glaucoma surgery as a prophylactic measure for the prevention of AM in CNAG.<h4>Methods</h4>Retrospective case series of six phakic eyes in four patients with C ...[more]

PMID: 30148233

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Project description:PurposeTo evaluate two different approaches of anterior vitrectomy combined with hyaloidotomy, zonulectomy, and iridectomy (VHZI) for fluid misdirection syndrome (FMS) secondary to phacoemulsification with intraocular lens implantation combined with goniosynechialysis (phaco-IOL-GSL).MethodsNine patients with FMS who developed after a phaco-IOL-GSL procedure, were retrospectively studied from May 2015 to February 2018. They were treated with VHZI, in which 5 cases underwent local anterior vitrectomy via anterior chamber approach, and the others underwent comprehensive vitrectomy via pars plana approach. Main outcome measures were pre- and postoperative intraocular pressure (IOP), number of antiglaucoma medications, and relapse rate.ResultsIncidence of FMS secondary to phaco-IOL-GSL was 1.4% (9 in 652 eyes), which was promptly resolved in all affected cases. VHZI via anterior chamber approach resulted in a significant decrease in the mean IOP from 40.2 ± 9.7 mm Hg at presentation to 15.2 ± 4.8 mm Hg postoperatively (P=0.01). The median number of antiglaucoma medications reduced from 3 to 2 (P=0.066). Meanwhile, VHZI via pars plana approach also resulted in the reduction of the mean IOP values from 26.0 ± 5.7 mm Hg at presentation to 15.2 ± 3.3 mm Hg postoperatively (P=0.092). The median number of antiglaucoma medications also reduced from 3.5 to 1.5 (P=0.059). Relapse rate of the treatment through pars plana approach (0%, 0/4) was much lower than that through anterior chamber approach (40%, 2/5), although the difference was not statistically significant (P=0.444).ConclusionsFMS is a rare but severe complication secondary to phaco-IOL-GSL. Compared to VHZI with local anterior vitrectomy via anterior chamber approach, VHZI with comprehensive anterior vitrectomy via pars plana approach might be a more effective procedure to treat FMS. The study has been registered in Contact ClinicalTrials.gov PRS Identifier: NCT04172857.

Project description:Importance:Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting. Objective:To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM. Design, Setting, and Participants:In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217?557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57?561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159?184 reference eyes were analyzed. Main Outcomes and Measures:We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery. Results:The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65?265 of 159?184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately?3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (?3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately?4 Snellen lines), with 48?583 of 77?408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77?408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125?435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P?<?.001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes. Conclusions and Relevance:On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

Dataset Information

Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection.

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Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection.

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