Clinical Ophthalmology (Mar 2020)
Outcomes of Cataract Surgery Complicated by Retained Lens Fragments Requiring Pars Plana Vitrectomy
Abstract
Weijie V Lin,1,* Megan N Scott,2,3,* Chosang Tendhar,4 Shazia F Ali,2,3 Zaina Al-Mohtaseb,2,3 Rizwan Shaikh,2,3 Christina Y Weng2,3 1School of Medicine, Baylor College of Medicine, Houston, TX, USA; 2Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA; 3Ben Taub General Hospital, Harris Health System, Houston, TX, USA; 4Office of Research, Assessment and Planning, Adelphi University, New York, NY, USA*These authors contributed equally to this workCorrespondence: Christina Y WengDepartment of Ophthalmology, Baylor College of Medicine, MBA Alkek Eye Center 1977 Butler Blvd., 3rd Floor, Houston, Texas 77030, USATel +1 713 798-6100Email [email protected]: To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees.Methods: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20).Main Outcomes/Measures: Visual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression.Results: The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥ 20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p< 0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3).Conclusions/Relevance: Despite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.Keywords: trainee, complicated cataract surgery, retained lens fragments, resident, fellow, pars plana lensectomy, pars plana vitrectomy, teaching, surgical education
