PHACOEMULSIFICATION FOR CATARACT FOLLOWING PARS-PLANA VITRECTOMY

BACKGROUND AND OBJECTIVE: To determine if the technical aspects of pha coemulsification for removal of cataract following pars plana vitrecto my differ from those of phacoemulsification for removal of cataract in nonvitrectomized eyes. PATIENTS AND METHODS: Twenty-two eyes that had undergone prior vitrectomy were identified through a retrospective re view of chart notes and operative records of 1039 consecutive cataract extractions performed by one surgeon. RESULTS: Complications of proli ferative diabetic retinopathy was the most common indication for prior vitrectomy. The predominant lens change was nuclear sclerosis. Deep a nterior chambers with large anterior to posterior excursions of the ir is lens diaphragm with simultaneous fluctuation in pupil size occurred during phacoemulsification. The posterior capsule was flaccid and mob ile during lens cortex removal. No posterior capsules ruptured. Postop erative visual acuity improved in 91% of the patients. CONCLUSIONS: Pr ior vitrectomy was associated with diabetes and nuclear sclerotic cata ract. Phacoemulsification in this patient population was associated wi th inadequate pupillary mydriasis, superior conjunctival scarring, int raoperative anterior chamber depth, pupil size, and iris lens excursio ns that hindered phacoemulsification tip placement. Posterior capsules were excessively flaccid, prone to rapid anterior and posterior excur sions, and may have plaques that are resistant to intraoperative remov al.