Cataract formation following vitreoretinal procedures

Abstract

Purpose: To evaluate the incidence and prevalence of cataract formation, progression, and extraction in patients that underwent vitreoretinal procedures and to evaluate factors that can potentially predispose patients to postoperative cataracts.

Materials and methods: The medical records of consecutive patients who underwent vitreoretinal surgery at the Yale Eye Center with at least 6 months of follow-up and no prior intraocular surgery were obtained. Preoperative, intraoperative, and postoperative data were recorded and analyzed in this retrospective observational study. The main outcome measures were defined as cataract extraction, formation, and progression after vitreoretinal procedures. The lens status of the surgical eye was recorded preoperatively and at 1 month, 3 months, 6 months, 12 months, 24 months, and 36 months postoperatively.

Results: A total of 193 eyes of 180 patients fulfilled the inclusion criteria. The percentages of eyes with mild lens change were 96% after 20-gauge pars plana vitrectomy (PPV), 72% after small gauge (23- and 25-gauge) PPV, 38% after scleral buckle (SB), 38% after pneumatic retinopexy (PR), and 91% after PPV plus SB (PPV+SB). Posterior subcapsular and nuclear sclerotic cataracts were the most common with almost all developing within 24 months. There was no statistically significant difference (P=1.00) between the rate of cataract extraction after 20-gauge (41%) and small gauge PPV (42%), but there was a statistically significant difference between PPV and non-PPV (SB, 6%; PR, 7%; P<0.001) and PPV and PPV+SB groups (69%; P=0.0063).

Conclusion: Cataracts were common following PPV regardless of the gauge. SB and PR led to the lowest while PPV+SB led to the highest risk of postoperative cataracts.

Keywords: cataracts; pneumatic retinopexy; scleral buckle; vitrectomy; vitreoretinal surgery.

Figure 1

Cataract extraction after vitreoretinal procedures. Notes: The cumulative fraction of eyes that underwent cataract surgery at various time points after vitreoretinal procedure showed that cataract surgery was commonly performed within 2 years postoperatively. PPV+SB had the highest rate of cataract extraction at 69%, while SB and PR had the lowest rates at 6% and 7%, respectively. A significant and similar proportion of eyes that underwent 20-gauge (41%) and small gauge (42%) vitrectomy needed cataract surgery postoperatively. Abbreviations: PPV, pars plana vitrectomy; SB, scleral buckle; PR, pneumatic retinopexy; PPV+SB, combined pars plana vitrectomy plus scleral buckle.

Figure 2

Visual acuity of the surgical eye. Notes: For the surgical eyes that underwent each vitreoretinal procedure, the average visual acuity improved after vitreoretinal surgery with subsequent deterioration postoperatively due to cataract formation or progression, as evidenced by improvement following cataract surgery. The exception is the SB group, where the mean visual acuity decreased after cataract surgery, which is due to the small sample size (n=2) with one eye showing improvement while the other showed deterioration. Mean and standard error of the visual acuity using the LogMAR scale is shown. Abbreviations: LogMAR, log of the minimum angle of resolution; PPV, pars plana vitrectomy; PR, pneumatic retinopexy; SB, scleral buckle; PPV+SB, combined pars plana vitrectomy plus scleral buckle; n, number.