Time to surgery may not impact PPV outcomes when removing lens fragments

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FORT LAUDERDALE, Fla. — Time to surgery may not have a strong impact on pars plana vitrectomy outcomes when treating retained lens fragments after cataract surgery, according to a speaker here at the Retina World Congress.

According to Harry W. Flynn, Jr. MD, risk factors for retained lens fragments after surgery may include a “very hard nucleus, pseudoexfoliation, previous vitrectomy, surgeon experience or lack of experience and movement during surgery.”

Harry W. Flynn, Jr. MD

Image: Alex Young | Healio

“Traditional approaches included to wait and let the eye ‘quiet down’ before you go in and move the lens material,” he said.

However, a retrospective, interventional consecutive case series that followed 246 patients who underwent pars plana vitrectomy (PPV) for retained lens fragments after cataract surgery found “no difference in outcomes whether you operated on day 1, week 1 or beyond week 1 in terms of visual acuity outcomes or retinal detachment rates.”

Of the total number of patients, 57% underwent same-day PPV, 13% underwent PPV the same week as cataract surgery and 30% underwent PPV longer than a week after cataract surgery.

According to Flynn, 67% of patients in both the same-day cohort and the same-week cohort had a visual acuity of 20/40 or better after PPV, while outcomes for patients who received PPV longer than a week later were “a little bit worse,” with 52% showing vision of 20/40 or better.

“The mean visual acuities were somewhat similar, and not statistically different from each other,” Flynn said.

Retinal detachment was experienced by 4% of patients in the same-day PPV cohort, 6% in the same-week cohort and 10% in the longer-than-a-week cohort (P > .05). These differences were not statistically significant.

Overall, the study saw favorable outcomes, with 63% of all patients showing a visual acuity of 20/40 or better and 19% showed a visual acuity of 20/200 or better after PPV.

“Same-day vitrectomy surgery spares the patient a repeat trip to the operating room but is not always available in many settings,” Flynn concluded.

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