Vitrectomy May Lead To Axial Length Changes in Patients With Concurrent Cataracts

Some patients with rhegmatogenous retinal detachment (RRD) and cataracts were found to have significant changes to their axial length (AL) following vitrectomy, according to a retrospective study published in BMC Ophthalmology.

The researchers took into account 213 patients (mean age 53.97 [range, 13-79] years, 120 boys and men) who underwent pars plana vitrectomy (PPV) with silicone oil (SO) tamponade, and subsequent removal between 2016 and 2021 at Fudan University in China. The primary outcome was the change in AL following vitrectomy.

Intraocular pressures (IOP) were significantly lower in eyes with RRD compared with eyes without RRD (mean, 12.67 vs 14.92 mm Hg, P <.001). Postoperative IOP increased in both the operated and contralateral eyes (mean, 17.57 vs 15.42 mm Hg).

At the time of SO removal, AL was an average of 25.98±2.87 mm, increasing to 26.25±3.07 mm after removal.

The change in AL was associated with preoperative extreme myopia, defined as an AL of at least 28 mm (OR, 3.306; 95% CI, 1.638-6.672; P =.001) and preoperative hypotony (OR, 2.771; 95% CI, 1.481-5.186; P =.001).

Among eyes with both extreme myopia and preoperative hypotony (n=15), the change in AL following PPV was 0.46±0.37 mm compared with 0.20±0.29 mm in eyes with neither condition (n=106). More eyes with extreme myopia (P =.002) and hypotony (P =.003) had a postoperative increase in AL of at least 0.3 mm.

The limitations of this study included the small sample size and the inclusion of only Chinese individuals, which may limit generalizability of these findings.

The study authors explain that AL changed after PPV for RRD in eyes with cataracts, especially in eyes with hypotony or extreme myopia, or both. In these cases, and cases where phacoemulsification was necessary during RRD treatment, secondary intraocular lens (IOL) implantation should be considered.

Reference

Shi J, Wu K, Wen H, et al. Change in axial length after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment. BMC Ophthalmol. 2022;22(1):257. doi:10.1186/s12886-022-02433-8