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A retrospective cohort study of clinical outcomes for intravitreal crystalline retained lens fragments after age-related cataract surgery: a comparison of same-day versus delayed vitrectomy

Clinical Ophthalmology. 2012;2012(default):1135-1148

 

Journal Homepage

Journal Title: Clinical Ophthalmology

ISSN: 1177-5467 (Print); 1177-5483 (Online)

Publisher: Dove Medical Press

Society/Institution: The Society of Clinical Ophthalmology

LCC Subject Category: Medicine: Ophthalmology

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


Vanner EA

Stewart MW

Liesegang TJ

Bendel RE

Bolling JP

Hasan SA

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 16 weeks

 

Abstract | Full Text

Elizabeth A Vanner,1 Michael W Stewart,2 Thomas J Liesegang,2 Rick E Bendel,2 James P Bolling,2 Saiyid A Hasan2 1Departments of Preventive Medicine and Health Care Policy and Management, Stony Brook University, Stony Brook, NY; 2Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, FL, USABackground: This analysis compared outcomes for same-day (under a no-move, no-wait policy) versus delayed vitrectomy for intravitreal crystalline retained lens fragments after surgery for age-related cataract.Methods: This was a retrospective, nonrandomized treatment comparison cohort study with a consecutive series of 35 eyes (23 same-day, 12 delayed) receiving both cataract surgery and vitrectomy at the Mayo Clinic Florida between 1999 and 2010. Outcome measures included visual acuity (VA), glaucoma progression, visual utility, and complications. Several techniques (bootstrapping, robust confidence intervals, jackknifing, and a homogeneous sample) were used to reduce selection bias and increase confidence in our small sample's results.Results: No significant baseline treatment group differences. Mean previtrectomy delay (12 eyes) was 40.9 days (median 29.5, range 1–166). Mean postvitrectomy follow-up (35 eyes) was 47.5 months (median 40.5, range 3.1–123.5). Same-day patients had significantly better final VA (adjusted for age [t = -2.14, P = 0.040] and precataract surgery VA [t = -2.98, P = 0.006]); a higher rate of good final VA (≥20/40), 78.3% (18/23) versus 58.3% (7/12); a lower rate of bad final VA (≤20/200), 4.3% (1/23) versus 25.0% (3/12); and fewer final retinal conditions, 4.3% (1/23) versus 50.0% (6/12). Same-day patients also had marginally significant better mean final VA in the operated eye (20/40 versus 20/90, Z = 1.51, P = 0.130) despite poorer initial VA (20/98 versus 20/75) and higher age (3+ years), better final visual utility, and longer survival times for better VA. Among patients with preexisting glaucoma, same-day patients experienced significantly less differential (operated versus nonoperated eye) glaucoma progression.Conclusion: Results favored same-day patients, who experienced better final VA and visual utility, less differential glaucoma progression, and fewer complications. Results need confirmation with larger samples.Keywords: intraoperative complications, retained lens fragments, visual acuity, glaucoma, evaluation studies, visual utility, statistics as topic, small nonrandomized sample analysis