A retrospective cohort study of clinical outcomes for intravitreal crystalline retained lens fragments after age-related cataract surgery: a comparison of same-day versus delayed vitrectomy

Elizabeth A Vanner,¹ Michael W Stewart,² Thomas J Liesegang,² Rick E Bendel,² James P Bolling,² Saiyid A Hasan^2
 
1Departments of Preventive Medicine and Health Care Policy and Management, Stony Brook University, Stony Brook, NY; ²Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, FL, USA

Background: This analysis compared outcomes for same-day (under a no-move, no-wait policy) versus delayed vitrectomy for intravitreal crystalline retained lens fragments after surgery for age-related cataract.
Methods: This was a retrospective, nonrandomized treatment comparison cohort study with a consecutive series of 35 eyes (23 same-day, 12 delayed) receiving both cataract surgery and vitrectomy at the Mayo Clinic Florida between 1999 and 2010. Outcome measures included visual acuity (VA), glaucoma progression, visual utility, and complications. Several techniques (bootstrapping, robust confidence intervals, jackknifing, and a homogeneous sample) were used to reduce selection bias and increase confidence in our small sample's results.
Results: No significant baseline treatment group differences. Mean previtrectomy delay (12 eyes) was 40.9 days (median 29.5, range 1–166). Mean postvitrectomy follow-up (35 eyes) was 47.5 months (median 40.5, range 3.1–123.5). Same-day patients had significantly better final VA (adjusted for age [t = -2.14, P = 0.040] and precataract surgery VA [t = -2.98, P = 0.006]); a higher rate of good final VA (≥20/40), 78.3% (18/23) versus 58.3% (7/12); a lower rate of bad final VA (≤20/200), 4.3% (1/23) versus 25.0% (3/12); and fewer final retinal conditions, 4.3% (1/23) versus 50.0% (6/12). Same-day patients also had marginally significant better mean final VA in the operated eye (20/40 versus 20/90, Z = 1.51, P = 0.130) despite poorer initial VA (20/98 versus 20/75) and higher age (3+ years), better final visual utility, and longer survival times for better VA. Among patients with preexisting glaucoma, same-day patients experienced significantly less differential (operated versus nonoperated eye) glaucoma progression.
Conclusion: Results favored same-day patients, who experienced better final VA and visual utility, less differential glaucoma progression, and fewer complications. Results need confirmation with larger samples.

Keywords: intraoperative complications, retained lens fragments, visual acuity, glaucoma, evaluation studies, visual utility, statistics as topic, small nonrandomized sample analysis