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Visual outcome and prognostic factors following posterior capsule rupture in cataract surgery

Poster Details

First Author: D.Agrawal INDIA

Co Author(s):    S. Chatterjee   N. Gupta   A. Sahu   N. Sarma   A. Singh   S. Malhotra

Abstract Details



Purpose:

Posterior capsule rupture (PCR) during cataract surgery is not an uncommon complication which is encountered by the anterior segment surgeon. Often the situation is complicated by dislocation of lens or its fragment into the vitreous cavity necessitating its removal through the pars plana route by a vitreo-retinal surgeon. But more commonly there is no such dislocation and the PCR is managed by the anterior segment surgeon by anterior vitrectomy. In this study we chose to examine the visual outcome, post-operative complications and predictors of poor visual outcome following management of PCR occurring during cataract surgery by the anterior segment surgeon.

Setting:

Cornea & Anterior Segment Services, MGM Eye Institute Raipur, India

Methods:

The medical records of all patients where PCR was encountered during cataract surgery were retrospectively reviewed. Inclusion criteria were PCR managed by automated anterior vitrectomy by anterior segment surgeon. Those patients where intervention by vitreo-retinal surgeon was required to remove lens fragment from vitreous cavity, cataract surgery combined with other intra-ocular surgeries, incomplete data, inability to record visual acuity, and incomplete follow-up were excluded. Main outcome measures were post-operative best corrected visual acuity (BCVA) as measured by logMAR visual acuity charts and post-operative complications. For statistical analysis good outcome was BCVA equal or better than 20/64 and poor outcome was BCVA less than 20/64. Variables to determine predictors of poor visual outcome included age, gender, type of cataract surgery (phacoemulsification versus non-phacoemulsification procedures), pseudophakic status and post-operative adverse events. Statistical analysis was done by constructing a 2x2 table to test for level of significance with Fisher's exact test. Visual acuity was converted to log values and means compared by Student T test. A p value less than 0.05 was considered to be statistically significant.

Results:

There were 48 patients with age ranging from 19-80 years (mean 61± 13 years) of which 27(56%) were males and 21(44%) were females. Phacoemulsification was performed in 24 (50%) patients, extra-capsular cataract extraction in 15 (31%) patients and small incision cataract surgery in 9 (19%) patients. A posterior chamber intra-ocular lens was implanted in 32 (67%) eyes and an anterior chamber intra-ocular lens in 11 (23%) eyes. Five (10%) eyes were left aphakic. Post-operative BCVA was 20/64 or better in 35 (73%) eyes, 20-80 to 20/200 in 12 (25%) eyes and less than 20/200 in 1 (2%) eyes. Post-operative adverse events were encountered in 15 (33%) eyes and included cystoid macular edema in 7(15%) eyes, ocular hypertension in 3 (6%) eyes, retinal detachment in 3 (6%) eyes, post-operative uveitis and decentered intra-ocular lens in 1 (2%) eye each. Predictors for poor visual outcome included failure to implant an intra-ocular lens (p=0.0154) and occurrence of post-operative adverse events (p=0.0001).

Conclusions:

Visual outcome following PCR management by automated vitrectomy by anterior segment surgeons in this series was good in majority of patients. Common adverse events were cystoid macular edema, retinal detachment and ocular hypertension. Predictors of poor vision were occurrence of post-operative adverse events and inability to implant an intra-ocular lens. FINANCIAL INTEREST: NONE

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