The role of patient age and intraocular gases in cataract progression following vitrectomy for macular holes and epiretinal membranes

Abstract

Purpose: To evaluate the rate of increase in nuclear sclerosis and posterior subcapsular cataracts in eyes as a function of patient age and use of intravitreal gas at the time of vitrectomy.

Methods: Nuclear sclerotic cataracts and posterior subcapsular cataracts were graded on a scale of 0 to 4.0 in 301 consecutive eyes prior and subsequent to vitrectomy for macular holes, epiretinal membranes, or vitreomacular traction syndrome. Linear regression analysis was performed to compare the rate of change in cataract score.

Results: Nuclear sclerotic cataracts showed minimal increase in patients younger than 50 years of age following vitrectomy (.13 grades per year). Nuclear sclerotic cataracts increased at a rate of .7 to .9 grades per year (mean, .812) in patients from age 50 to 60, 60 to 70, 70 to 80, and 80+ years, even though the baseline nuclear sclerosis scores were progressively greater for each decade. The increase in nuclear sclerotic cataracts in patients younger than 50 years was significantly less (P<.001) than in patients 50 years or older. The fellow nonsurgical eyes of patients 50 years or older also showed smaller increases in nuclear sclerotic cataracts over time (.091 to .342 grades per year; mean, .139). Eyes with intraocular gas use had a higher rate of nuclear sclerosis progression (.8 grades per year) compared to eyes without intraocular gas bubbles (.5 grades per year) (P<.001). Posterior subcapsular cataract scores showed minimal or no increases in all groups.

Conclusions: Patients older than 50 years have a similar rate of increase in nuclear sclerotic cataracts independent of age. The rate is sixfold greater than in patients younger than 50 years and also sixfold greater than the progression of nuclear sclerosis in the fellow nonsurgical eyes. Intravitreal gas bubbles cause nuclear sclerosis to increase by 60%, compared to eyes without use of a gas bubble.