Purpose

To analyze the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy (PPV).

Design

Retrospective, multicenter database study.

Participants

Eyes that underwent phacoemulsification between June 2005 and March 2015 at 8 sites in the United Kingdom.

Methods

Study eyes were classified as vitrectomized (prior PPV group) or nonvitrectomized (reference group) depending on the vitreous state at the time of cataract surgery. Eyes with multiple intraocular surgeries or history of ocular diseases known to cause cataract progression or increased risk of intraoperative complications during phacoemulsification were excluded.

Main Outcome Measures

Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), rate of intraoperative complications, and time interval to cataract surgery.

Results

Eyes in the prior PPV group (n = 2221) had worse preoperative logMAR VA (0.96±0.60 vs. 0.62±0.52, P < 0.0001), were from younger patients, and had longer axial lengths than the nonvitrectomized group (n = 136 533). At all postoperative time points measured up to 24 weeks, mean vision was poorer in the prior PPV group (0.41±0.47 vs. 0.17±0.29 at 4–12 weeks, P < 0.0001) and a smaller proportion of eyes achieved postoperative VA ≤0.30 logMAR (Snellen, ≥20/40) (60.8% vs. 86.5% at 4–12 weeks, P < 0.0001). The rate of posterior capsular rupture was not different between the prior PPV (1.5%) and the nonvitrectomized (1.7%) groups, but the incidences of zonular dialysis (1.3% vs. 0.6%) and dropped nuclear fragments (0.6% vs. 0.2%) were higher in the prior PPV group (P < 0.0001). The mean time interval between PPV and cataract surgery was 399 days.

Conclusions

We found a significant improvement in VA with postvitrectomy cataract surgery. However, compared with eyes without prior PPV, there was a worse mean postoperative vision of 0.2 logMAR units, a higher rate of zonular dialysis and dropped nuclear fragments, and a similar rate of posterior capsule rupture.

中文翻译：

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玻璃体切除术后白内障手术的视觉结果和术中并发症的数据库研究

目的

目的分析前房镜玻璃体切除术（PPV）后超声乳化手术的视觉结果和术中并发症发生率。

设计

回顾性多中心数据库研究。

参加者

2005年6月至2015年3月在英国的8个地点进行了超声乳化手术。

方法

根据白内障手术时的玻璃体状态，将研究眼分为玻璃体切除术（PPV之前的组）或非玻璃体切除术（参考组）。排除了在白内障超声乳化术中进行多次眼内手术或有导致白内障进展或增加术中并发症风险的眼科疾病史的眼睛。

主要观察指标

最小分辨角（logMAR）视敏度（VA），术中并发症发生率和白内障手术时间间隔的对数。

结果

PPV先前组（n = 2221）的术前logMAR VA较差（0.96±0.60 vs. 0.62±0.52，P < 0.0001），来自年轻患者，且轴长比非玻璃体切除术组（n = 136 533） ）。在长达24周的所有术后时间点上，先前的PPV组的平均视力较差（4–12周时为0.41±0.47 vs. 0.17±0.29，P < 0.0001），并且较小的眼睛术后视觉VA≤0.30 logMAR（Snellen，≥20/ 40）（4-12周时分别为60.8％与86.5％，P < 0.0001）。先前的PPV组（1.5％）和未玻璃体切除术的组（1.7％）之间的后囊破裂率没有差异，但是小带透析的发生率（1.3％对0.6％）和核碎片掉落的发生率（0.6％对0.2％） ％）在先前的PPV组中更高（P < 0.0001）。PPV和白内障手术之间的平均时间间隔为399天。

结论

我们发现玻璃体切除术后白内障手术可显着改善VA。但是，与没有事先PPV的眼睛相比，术后平均视野差为0.2 logMAR单位，小带透析率更高，核碎片掉落的率更高，后囊破裂的发生率相似。