PPV Timing for Retained Lens Fragment Does Not Affect Visual Outcomes, Detachment Rates

Pars plana vitrectomy (PPV) timing for retained lens fragments (RLF) after cataract surgery does not affect patients’ visual outcomes or rates of retinal detachment, according to a study published in Clinical Ophthalmology. The optimal timing of PPV for RLF has been previously debated, the current study demonstrates that later PPV does not appear to compromise results, the authors claim.  

This retrospective study included 246 eyes of 246 patients who received pars plana vitrectomy to correct RLF after cataract surgery at the department of ophthalmology of Bascom Palmer Eye Institute, Miami, Between January 1, 2012, and September 30, 2020.

Patients were allocated into 1 of 3 groups based on PPV timing for retained lens fragment: the same day, within 1 week (mean interval to PPV, 5±1.8 days), and more than 1 week (mean interval to PPV, 31±22.3 days). The same-day group included 140 eyes (57%), within 1 week of 33 eyes (33%), and more than 1 week of 73 eyes (30%). No significant differences in mean age between groups were found (70.0±10.4, 70.9±7.9, 71.2±11.9 years, respectively, P =.69).

No differences in best-corrected visual acuity (BCVA) before cataract surgery or pre-vitrectomy were detected between the groups (P =.06, P =.33, respectively). 

A pre-existing corneal endothelial disease was more prevalent in the more than 1-week group (5.5%) than in the same-day group (0.7%) (P =.04). An increased number of eyes in the same-day group had diabetic retinopathy, compared with the 1-week group. There were no differences in rates of all other pre-existing ocular conditions between groups (P >.05).

No significant differences in the proportions of eyes implanted with posterior chamber intraocular lens (IOL), anterior chamber IOL, and that remained aphakic, were found between the groups (P =.63).

The PPV timing for retained lens fragments did not result in a significant difference between the mean postoperative BCVA at 3 months (P =.07). The same-day group had significantly better mean BCVA after 6 months compared with the more than 1-week group (P =.04), but the researchers noted no differences among the other groups (P >.05). Mean BCVA at the last follow-up was comparable between the groups (P =.07). No differences in the proportions of eyes with last visit BCVA of 20/40 or better, or with last visit BCVA of 20/200 or worse were found between the groups (P =.09 for both). Retinal detachment rates were comparable between the groups (P =.33).

The team did a second analysis that reviewed PPV timing for retained lens 

fragments only in eyes without pre-existing ocular diseases (n=157). No differences were found between the mean BCVA at 3 months, 6 months, or at the last visit between the groups (P =.80, P =.59, P =.84, respectively). No differences in the proportions of eyes with last visit BCVA of 20/40 or better or with last visit BCVA of 20/200 or worse were found between the groups (P =.61 for both). Retinal detachment rates were comparable between the groups (P =.45).

The optimal PPV timing for retained lens fragments has been a matter of debate, according to the study authors. “The current study did not detect differences in BCVA at last follow-up examination in patients who received same-day, same-week, or more than one-week PPV.”

“Prompt PPV might not be available in many instances, so the finding that outcomes do not seem to be disadvantaged by a delay is pertinent,” the study authors explain. 

The limitations of the study include its retrospective nature. In addition, Certain factors, such as the type of posterior chamber intraocular lens and degree of RLF, were not assessed but may have influenced outcomes.