PHACOEMULSIFICATION AND LENS IMPLANTATION AFTER PARS-PLANA VITRECTOMY

Objective: This study aimed to describe the intraoperative and postope rative complications and visual acuity outcomes of patients undergoing Kelman phacoemulsification (KPE) and intraocular lens (IOL) implantat ion after pars plana vitrectomy (PPV). Design: The study design was a retrospective review of a consecutive surgical series. Participants: F orty-four eyes of 43 patients who underwent surgery at the Jules Stein Eye Institute, Los Angeles, California, or Advanced Vision Care, West Hills, California, were studied, Intervention: Office records, referr ing retina specialists' records, and operative reports were reviewed f or demographic information, indications for PPV, preoperative cataract severity, unplanned intraoperative events and complications, early an d late postoperative complications, and postoperative visual acuities, Main Outcome Measures: Complications and postoperative visual acuitie s were measured. Results: The mean interval from PPV to KPE was 20 mon ths. The mean interval from KPE to final examination was 19 months. Pr imary indications for PPV included development of a macular epiretinal membrane, macular hole, proliferative diabetic retinopathy, retinal d etachment, vitreous abscess, and vitreous hemorrhage. The degree of nu clear sclerosis in postvitrectomy eyes was greater than that in typica l cataract eyes (P = 0.00002). The most common intraoperative problem was the discovery of a posterior capsule plaque. In a few cases, surge ry was made difficult by unusual fluctuations in anterior chamber dept h and lens zonule instability. The most common early postoperative com plication was corneal edema; the most common late complication was the need for neodymium:YAG (Nd:YAG) laser posterior capsulotomy. An IOL w as implanted in every eye. There were no retinal detachments. Median v isual acuity improved from 20/125 before cataract surgery to 20/40 6 w eeks after surgery to 20/30 on final examination, Visual acuity of 20/ 40 or better was achieved by 63.6% of eyes at 6 weeks and by 72.7% of eyes by final examination. Conclusions: Kelman phacoemulsification and IOL implantation can be performed safely after PPV. Intraoperative an d postoperative complications are uncommon. Pre-existing posterior seg ment pathology limits the ultimate improvement in visual acuity, but s ubstantial gains in visual acuity are realized by most patients.