A Database Study of Visual Outcomes and Intraoperative Complications of Postvitrectomy Cataract Surgery

Purpose: To analyze the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy (PPV). Design: Retrospective, multicenter database study. Participants: Eyes that underwent phacoemulsification between June 2005 and March 2015 at 8 sites in the United Kingdom. Methods: Study eyes were classified as vitrectomized (prior PPV group) or nonvitrectomized (reference group) depending on the vitreous state at the time of cataract surgery. Eyes with multiple intraocular surgeries or history of ocular diseases known to cause cataract progression or increased risk of intraoperative complications during phacoemulsification were excluded. Main Outcome Measures: Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), rate of intraoperative complications, and time interval to cataract surgery. Results: Eyes in the prior PPV group (n = 2221) had worse preoperative logMAR VA (0.96 +/- 0.60 vs. 0.62 +/- 0.52, P < 0.0001), were from younger patients, and had longer axial lengths than the nonvitrectomized group (n = 136 533). At all postoperative time points measured up to 24 weeks, mean vision was poorer in the prior PPV group (0.41 +/- 0.47 vs. 0.17 +/- 0.29 at 4-12 weeks, P < 0.0001) and a smaller proportion of eyes achieved postoperative VA <= 0.30 logMAR (Snellen, >= 20/40) (60.8% vs. 86.5% at 4-12 weeks, P < 0.0001). The rate of posterior capsular rupture was not different between the prior PPV (1.5%) and the nonvitrectomized (1.7%) groups, but the incidences of zonular dialysis (1.3% vs. 0.6%) and dropped nuclear fragments (0.6% vs. 0.2%) were higher in the prior PPV group (P < 0.0001). The mean time interval between PPV and cataract surgery was 399 days. Conclusions: We found a significant improvement in VA with postvitrectomy cataract surgery. However, compared with eyes without prior PPV, there was a worse mean postoperative vision of 0.2 logMAR units, a higher rate of zonular dialysis and dropped nuclear fragments, and a similar rate of posterior capsule rupture. (C) 2018 by the American Academy of Ophthalmology