Pars plana lensectomy combined with pars plana vitrectomy for dislocated cataract

Abstract

PURPOSE: To assess the prognosis and complications after pars plana vitrectomy (PPV) combined with lensectomy as a primary procedure for visual correction of complicated cataract. SETTING: Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA. METHODS: This retrospective study reviewed the preoperative, intraoperative, and postoperative clinical features in eyes that had PPV combined with lensectomy as a primary procedure for complicated cataract without severe posterior segment pathology (study group). The corrected distance visual acuity (CDVA), reoperations, retinal detachment (RD), and cystoid macular edema (CME) were ascertained. Results were compared with those in a control group of eyes having combined PPV and lensectomy for uncomplicated cataract. RESULTS: In the study group (40 patients), 23 eyes had traumatic lens dislocation, 12 had Marfan syndrome, 7 had idiopathic lens dislocation, and 4 had pseudoexfoliation syndrome. The median corrected distance visual acuity improved from 20/185 (range 20/20 to hand motions) preoperatively to 20/30 (range 20/20 to hand motions) 3 months postoperatively (P<.001). The postoperative CDVA was poorer in cases with an etiology of trauma (P = .018). Complications included RD (6.5%), transient vitreous hemorrhage (13.0%), choroidal detachment (4.3%) and CME (13.00/0), which occurred more frequently in eyes with a history of trauma (P = .022). The control group (43 eyes; 42 patients) had 1 (2.3%) RD. CONCLUSIONS: Pars plana vitrectomy with lensectomy yielded favorable visual outcomes in eyes with complicated cataract in which standard anterior segment techniques were prohibitive or risky. However, preexisting conditions and postoperative complications may limit visual outcomes.