Prior pars plana vitrectomy and its association with adverse intraoperative events during cataract surgery

Acta Ophthalmol. 2021 Jun 16. doi: 10.1111/aos.14947. Online ahead of print.

Abstract

Purpose: To evaluate the risk of intraoperative complications during cataract surgery in eyes with a prior vitrectomy.

Methods: A retrospective review of data from our cataract surgery registry of all patients undergoing cataract surgery between 2014 and 2018 at the University of Colorado Hospital. Univariate and multivariate analyses were conducted, accounting for intra-patient correlation in subjects who underwent two cataract surgeries. The three main outcomes of interest, zonulopathy, posterior capsule (PC) tears and dropped lens fragments, were analysed for their association with prior pars plana vitrectomy (PPV) and clinical characteristics of patients such as history of prior intravitreal injection and surgeon level of experience.

Results: 10 540 eyes of 6447 patients were included in the analysis. 371 (3.5%) eyes had a prior PPV. Eyes with a prior PPV experienced more zonulopathy during cataract surgery (adjusted OR 2.2, 95% confidence interval: 1.3-3.7, p = 0.002). Combined phacoemulsification/PPV were significantly more likely to experience all 3 complications, and this effect was even greater for eyes with a prior PPV.

Conclusions: All complications were rare; however, there was a significant association with prior PPV and intraoperative zonulopathy. Cataract surgeons must be aware of a patient's prior vitrectomy and plan accordingly for the increased risk of intraoperative complications.

Keywords: complex cataract surgery; dropped nuclear fragments; intraoperative complications; pars plana vitrectomy; phacoemulsification; posterior capsule tear; zonulopathy.