Posterior subcapsular and nuclear cataract after vitrectomy

Purpose: To examine the morphological changes in the postvitrectomy lens an d to monitor the development of these changes over time. Setting: Oxford Eye Hospital, Oxford, United Kingdom. Methods: In this prospective study, 33 consecutive phakic patients having p ars plana vitrectomy were recruited. Cataract development was quantified by clinical grading and digital Scheimpflug image analysis. Slitlamp biomicro scopy and photography were used to document the morphological appearance. T he main outcome measures were the incidence, morphology, and development of posterior subcapsular and nuclear cataract. Results: A characteristic, transient posterior subcapsular cataract (PSC) w as present in 89% (17 of 19) of tamponade patients within 24 hours of surge ry. Of the patients who had vitrectomy without tamponade, 9% (1 of 11) deve loped similar changes. Nuclear opacity developed in 61% (11 of 18) of tampo nade patients and in 50% (3 of 6) of nontamponade patients. A longer term r etrospective review of the same patients' case notes revealed nuclear catar act in 67% (12 of 18) of tamponade cases and 30% (3 of 10) of nontamponade cases. Eighteen percent (2 of 11) of nontamponade cases and 67% (14 of 21) of tamponade cases had cataract surgery after a 10.7 month and a 12.4 month follow-up, respectively. Conclusions: Vitrectomy and tamponade produced a characteristic transient P SC in the immediate postoperative period. Disruption of fluid balance in th e region of the posterior lens was suggested by the morphological appearanc e. The acute changes resolved but were followed by accelerated nuclear opac ilication. (C) 2001 ASCRS and ESCRS.