Time Course of Development of Posterior Vitreous Detachments after Phacoemulsification Surgery

Posterior vitreous detachment rates post-uncomplicated phacoemulsification surgery: a systematic review

PURPOSE

It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments.

METHODS

A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager.

RESULTS

A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length.

CONCLUSIONS

The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.

Pseudophakia as a surprising protective factor in neovascular age-related macular degeneration

PURPOSE

To assess the impact of lens status on macular function among patients treated for neovascular age-related macular degeneration (nvAMD) in whom scheduled intravitreal injections were delayed.

METHODS

We reviewed demographic and clinical data as well as macular optical coherence tomographic images of 34 patients (48 eyes) who did not follow their injection schedule during the first wave of COVID-19 in Israel. Functional worsening was defined as a loss of at least 0.1 in decimal best-corrected visual acuity (BCVA). Morphological worsening was defined as new or increased subretinal/intraretinal fluid or a new hemorrhage. OCT indices of quality were used as a measure for cataract density and progression.

RESULTS

Pseudophakia was associated with a better functional outcome than phakic status: there was a loss of 0.06±0.12 vs. 0.15±0.10 decimal BCVA in the pseudophakic and phakic eyes, respectively (P=.001). A similar trend was observed for morphological changes over the same period: there was an increase in macular thickness of 9±26% vs.12±40%, respectively (P=0.79). During the first wave of COVID-19, the index of OCT quality remained stable for phakic eyes (26±3.6 before the first wave of COVID-19, 26±2.9 afterward; P=1) and pseudophakic eyes (30±2.4 before the first wave of COVID-19, 30±2.6 afterward; P=1).

CONCLUSION

Pseudophakic eyes with nvAMD that missed their scheduled intravitreal injections experienced fewer morphological and functional complications than phakic eyes with nvAMD.

Incidence of rhegmatogenous retinal detachment following macular surgery in France between 2006 and 2016

PURPOSE

To report the incidence of postoperative rhegmatogenous retinal detachment after macular surgery in France between 2006 and 2016 and identify associated factors.

DESIGN

Nationwide population-based cohort study.

METHODS

All surgical procedures for an epiretinal membrane or a macular hole performed in France from January 1, 2006 to October 31, 2016 were identified in the French national administrative database (Programme de Médicalisation des Systèmes d'Information). We investigated the incidence of rhegmatogenous retinal detachment occurring within 90 days of a macular surgical procedure.

RESULTS

From January 1, 2006 to October 31, 2016, 152,034 macular surgical procedures for epiretinal membranes or macular holes were recorded in France. We identified 3,605 cases of rhegmatogenous retinal detachment occurring within 90 days of the procedure. The incidence of rhegmatogenous retinal detachment was 2.37% overall, 1.95% for epiretinal membrane surgery and 3.43% for macular hole surgery. In multivariable Poisson regression analysis, rhegmatogenous retinal detachment was associated with macular hole surgery (incidence rate ratio [IRR], 1.76; 95% CI, 1.63-1.90; P < .001), history of cataract extraction in the previous year (IRR, 1.20; 95% CI, 1.08-1.34; P = .001), age < 60 years (P < .001), and male gender (IRR, 1.63; 95% CI, 1.51-1.76; P < .001).

CONCLUSIONS

The incidence of rhegmatogenous retinal detachment within 90 days of macular surgery was 2.37% overall in France between 2006 and 2016 and it was higher for macular hole surgery than for epiretinal membrane surgery.

Effect of Anterior Chamber Instability during Phacoemulsification Combined with Intraocular Lens Implantation

Purpose

To determine the incidence of anterior chamber (AC) instability during phacoemulsification (phaco) combined with intraocular lens implantation and investigate its effect on intraocular tissues.

Methods

Among the 248 enrolled eyes, 121 and 127 eyes were categorized into the irrigation and nonirrigation groups, respectively, depending on the use of a self-made anterior chamber maintainer (ACM) during phaco. AC stability was evaluated using operating microscopy and intraoperative optical coherence tomography (iOCT). Slit-lamp examination of AC flare and cells was performed 1 day postoperatively. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), posterior vitreous detachment (PVD), and central foveal thickness (CFT) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively.

Results

There was good consistency in AC stability evaluation between operating microscopy and iOCT. The incidence of AC instability was significantly different between groups after the phaco and irrigation/aspiration tips were withdrawn from the AC (P < 0.001). At 1 day postoperatively, after excluding eyes in which the AC could not be visualized, AC cell grades were significantly lower in the irrigation group (P = 0.014). There was no significant difference in CDVA, IOP, ECD, and CCT between groups during the 3-month follow-up (P > 0.05). At 1 month and 3 months postoperatively, PVD occurred in 8 (16.3%) and 14 (28.6%) eyes and in 22 (40.7%) and 37 (68.5%) eyes in the irrigation and nonirrigation groups, respectively (P = 0.006 and P < 0.001). CFT was significantly higher in the nonirrigation group at 1 and 3 months postoperatively (P = 0.018 and P = 0.010).

Conclusions

Both operating microscopy and iOCT are efficient for AC stability evaluation. When the phaco and I/A tips were withdrawn from the AC, there was frequent instability. Intraoperative AC instability can increase surgery-induced inflammation and lead to postoperative complications such as PVD, retinal detachment, and macular edema. The self-made ACM can effectively reduce the incidence of intraoperative AC instability and these complications.

Efficacy and complications of cataract surgery in high myopia

To evaluate the efficacy and complications of cataract surgery in high myopia, a comprehensive search query was conducted from January 2000 to August 2020. A total of 19 586 highly myopic eyes from 28 studies were included. Modern cataract surgery turns out efficacious in highly myopic eyes with significant improvement of visual acuity. However, phacoemulsification-related complications such as posterior capsular rupture (3.91%, 95% CI, 1.98%-6.37%), retinal detachment (1.74%, 95% CI, 1.36%-2.15%), progressed myopic traction maculopathy (5.07%, 95% CI, 1.80%-9.37%), capsular contraction syndrome (2.1%), intraocular lens dislocation (0.58%), and transient intraocular pressure elevation (28.15%, 95% CI, 20.29%-36.70%) occurred more frequently in the highly myopic population. Separate analyses were also conducted based on follow-up period. In conclusion, modern cataract surgery was effective for highly myopic cataract patients, whereas careful precautions and sufficient follow-ups were of great value because of higher incidences of intraoperative and postoperative complications.

PROGRESSION OF PARTIAL POSTERIOR VITREOUS DETACHMENT OVER TIME

PURPOSE

We investigated interindividual differences in the rate of change of posterior vitreous detachment (PVD) stage and vitreomacular adhesion area (VMAA). Crosssectional studies demonstrated increasing PVD stage and decreasing VMAA with age, but population-level means may mask interindividual variation in the rate of change.

METHODS

We retrospectively evaluated PVD stage and VMAA in asymptomatic eyes of subjects who underwent repeated optical coherence tomography screening for high-risk medication use or isolated retinal disease in the fellow eye. A Turnbull estimator modeled changes in the PVD stage, and linear mixed models evaluated VMAA change.

RESULTS

We evaluated 101 eyes of 101 subjects. Seventy-six eyes remained in the same stage. Twenty-three eyes progressed to a higher stage. Modeling of longitudinal data predicts that at age 30, time to convert to Stage 4 is 26 years; at age 40, it is 16 years; at age 50, it is 9 years; and at age 60, it is 8 years. In 37 eyes with Stage 1 partial PVD, VMAA decreased at a similar rate. The average population level decline in VMAA was 0.13 mm2/year.

CONCLUSION

Individuals vary in age at which they progress to complete PVD. In early partial PVD, VMAA decreases at a similar rate across individuals.

Vitreomacular interface after anti-VEGF injections in diabetic macular edema

Background

The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome.

Methods

This was a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA diagnosed by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500 μm) or broad (attachment: > 1500 μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release.

Results

The mean patient age was 61.4 years (range: 29 to 78 years), and 72.7 % were male. The mean best-corrected visual acuity was 0.62 logMAR, and the mean central retinal thickness (CRT) was 473 μm at baseline. The mean length of follow-up was 18.5 months, and the mean number of injections was 5.8. The intravitreal drugs used were aflibercept (40.9 %), ranibizumab (37.9 %) and bevacizumab (21.2 %). Forty-seven eyes had broad VMA, and 19 had focal VMA. Twenty-two eyes (33.3 %) developed VMA release following a mean of 5.7 injections (range: 3–13). Sixteen eyes (72.7 %) with focal VMA and 6 eyes (27.3 %) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed an improvement in CRT following VMA release (mean: -106 μm; range: 22 to 289 μm).

Conclusions

VMA release occurs in approximately 1/3 of patients with DME following anti-VEGF therapy. Most of them show a short-term decrease in CRT.

Incidence of posterior vitreous detachment after congenital cataract surgery: an ultrasound evaluation

BACKGROUND

To investigate the incidence of developing posterior vitreous detachment (PVD) in children after congenital cataract surgery.

METHODS

This is a prospective study which recruited 131 children with congenital cataracts who underwent cataract surgery between June 1, 2015, and September 1, 2018. The patients were divided into two groups depending on their post-operation phakic status (with or without IOL implantation). Infants aged from 6 to 12 months from two groups were analyzed as subgroups, respectively. B-scan ultrasonography was performed before the procedure and at 1, 3, 6, 9, and 12-month follow-ups, respectively, after the operation.

RESULTS

Of the 131 eyes included in the analyses, 74 were aphakic, and 57 were pseudophakic after surgery. The postoperative rate of PVD in all analyzed eyes was 6.9% (9 of 131 eyes). After 12 months, PVD was significantly more prevalent in the eyes that underwent cataract surgery with IOL implantation (10.5%, 6 of 57 eyes) compared to the eyes without IOL implantation (4.1%, 1 of 74 eyes, P < 0.05); however, the eyes in the aphakic group were significantly younger than the eyes in the pseudophakic group, while the mean axial length (AL) of the pseudophakic eyes (21.11 ± 2.07 mm) was significantly higher than that of the aphakic eyes (18.93 ± 1.86 mm) (P < 0.01). In patients between the ages of 6 and 12 months of age from the two groups, the AL of patients with IOL implantation continued to be significantly increased compared to the group without IOL implantation (20.44 ± 1.68 mm vs. 19.78 ± 1.52 mm, P < 0.01). At the follow-up appointments, two patients with PVD were observed among the 14 eyes that had undergone cataract surgery with IOL implantation, while one eye was observed to have developed PVD among the 15 eyes without IOL implantation.

CONCLUSIONS

PVD occurs with greater frequency after congenital cataract surgery, particularly in eyes that have undergone IOL implantation. We suggest that PVD should be carefully monitored in children after congenital cataract surgery to avoid subsequent ocular pathologies such as retinal detachment. Future studies are needed to determine other potential risk factors that have not been as thoroughly explored, as opposed to better-known factors such as older age, longer axial length, and IOL implantation.

Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery

PURPOSE

To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery.

DESIGN

Retrospective case series.

PARTICIPANTS

Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months.

METHODS

Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis.

MAIN OUTCOME MEASURES

Onset or development of PVD at the VMI.

RESULTS

Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P = 0.046, P = 0.004, P = 0.040, P < 0.001, P < 0.001, P = 0.008, and P = 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P = 0.005, respectively).

CONCLUSIONS

The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.

Standard 6-mm Compared with Widefield 16.5-mm OCT for Staging of Posterior Vitreous Detachment

PURPOSE

To assess whether 6-mm OCT scans, which image the macula, can distinguish complete from partial posterior vitreous detachment (PVD) in comparison with 16.5-mm OCT scans, which image the macula, optic nerve, and mid periphery.

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS

We compared 6-mm and 16.5-mm scans in 157 eyes of 157 retina clinic patients (mean age, 50 years; range, 10-64 years) with diabetic retinopathy (36%), no retinal disease (19%), and various retinal conditions (45%). We also analyzed 16.5-mm scans in 35 healthy eyes (asymptomatic fellow eyes of patients with unilateral retinal conditions; mean age, 46 years; range, 9-63 years).

METHODS

Each participant underwent Heidelberg Spectralis imaging with the standard lens (6-mm scan) and/or the 55° lens (16.5-mm scan). On 6-mm scans, we classified eyes as stage 3 partial PVD when the posterior vitreous cortex was visualized without visible attachment. On 16.5-mm scans, we classified eyes as stage 3 when the vitreous was attached at the optic nerve and separated from the macula. On both scan types, we classified eyes as stage 4 when neither the premacular bursa nor the posterior vitreous cortex were visualized. We assessed the accuracy of this system for detecting complete PVD on 6-mm scans by calculating test characteristics using 16.5-mm scans as a reference standard.

MAIN OUTCOME MEASURE

Posterior vitreous detachment stage (0-4).

RESULTS

Posterior vitreous detachment stage was identical in 6-mm and 16.5-mm scans in 88% of eyes. Compared with 16.5-mm scans, 6-mm scans detected complete PVD (vs. earlier stages 0-3) with 91% sensitivity and 99% specificity. Seven eyes were classified as no PVD on 6-mm scans and were classified as partial PVD on 16.5-mm scans because vitreoretinal separation was localized to the mid periphery. All 16.5-mm scans showed some degree of PVD, including scans from 9 participants between 9 and 20 years of age.

CONCLUSIONS

Six-millimeter scans distinguished complete from partial PVD with good sensitivity and specificity but missed the earliest stages of PVD, which occur in the mid periphery. Posterior vitreous detachment may begin as early as the second decade of life.

Survey of Ehlers-Danlos Patients' ophthalmic surgery experiences

Background

Ehlers‒Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients.

Methods

Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists.

Results

Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%‐refractive, 33%‐lens/cataract, 33%‐retina, 59%‐strabismus, 23%‐ oculoplastics, 0%‐cornea, and 25%‐glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis.

Conclusions

Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery.

Prognostic factors of postoperative intraretinal cystoid spaces after primary pars plana vitrectomy for vitreomacular traction

Purpose

To study the anatomical and surgical prognostic factors related to developing postoperative intraretinal cystoid spaces (ICS) six months after 25-gauge pars plana vitrectomy (PPV) for vitreomacular traction (VMT).

Methods

The study is a retrospective case series of patients presenting with VMT treated primarily with PPV. All patients underwent 25-gauge PPV by the same retina surgeon. Intra-operative parameters were all recorded. Postoperative visual acuity (VA), foveal thickness, and ICS were collected over six months of follow-up. ICS were defined as hyporeflective cysts divided by hyperreflective septa on optical coherence tomography (OCT). Patients with ICS persistence 3 months postoperatively received topical treatment extension. The primary outcome measure was odds of preoperative ICS in patients with postoperative ICS compared to controls. Secondary outcome measures were odds of presence of an attached hyaloid to the optic disc, presence of pseudophakia, the use of intra-operative air, and the use of more than one intra-operative indocyanine green (ICG) injections in patients with postoperative ICS compared to controls.

Results

Two hundred and eighty treatment-naïve patients with preoperative diagnosis of epiretinal membrane (ERM) were reviewed. Thirty patients with VMT, confirmed both preoperatively on OCT and intra-operatively, were included. Postoperatively, 40% (n = 12) presented with ICS at 6 months. Among these, 83% (n = 10) had ICS prior to PPV. Patients presenting with preoperative ICS were significantly more at risk of having persistent ICS postoperatively (P < 0.05). The following factors did not statistically affect ICS occurrence: optic disc hyaloid attachment status, phakia/pseudophakia, intra-operative air vs. sulfur hexafluoride (SF₆), and the number of intra-operative ICG injections.

Conclusions

Our data demonstrate a predictive relationship between the occurrence/persistence of ICS post-PPV for VMT and the initial foveal status. Specifically, having preoperative ICS is a major risk factor for its persistence postoperatively. Our data highlight the pathophysiological importance of the vitreous phase and its effect on visual prognosis.

The vitreopapillary interface in healthy and glaucoma: posterior vitreous detachment in the vitreopapillary interface study

PURPOSE

To investigate the vitreopapillary interface (VPI) in health and glaucoma according to the different stages of posterior vitreous detachment (PVD) formation.

METHODS

Prospective single centre study including healthy subjects and glaucoma patients. PVD staging was performed with spectral domain optical coherence tomography. Gender, age, lens status and refractive error were assessed in both groups. Glaucoma patients additionally had a comprehensive ophthalmological investigation including intraocular pressure measurement, visual field testing and confocal imaging of the optic nerve head.

RESULTS

Data on 523 subjects (993 eyes) were included from the VPI study (clinicaltrials.gov NCT02290795) database (493 eyes of 258 healthy subjects and 500 eyes of 265 glaucoma patients). Healthy subjects were significantly younger than primary open angle glaucoma patients (59.7 ± 14.81 versus 70.0 ± 10.78 years, p < 0.001), but were otherwise matched for refractive error and gender. Significantly more glaucomatous eyes were pseudophakic (26.6% versus 5.1%). Including only phakic nonoperated eyes from subjects between 50 and 80 years old decreased the age difference between healthy and open angle glaucoma (64.1 ± 8.0 versus 65.9 ± 6.7 years, p = 0.051). Comparing these subgroups rendered similar average ages for PVD stages 0 and 4, in contrast to the significant older age for the glaucoma subgroup in stage 1 (64.1 ± 6.01 versus 61.4 ± 8.38 years, p < 0.001) and a trend towards significance in stage 3 (70.8 ± 69.8 versus 67.5 ± 5.92 years, p = 0.051).

CONCLUSION

The VPI study is a large clinical trial investigating the VPI in health and glaucoma. A subset of glaucoma patients seems to experience stages 1-3 of PVD formation at older age compared to healthy subjects.

Retinal detachment after acute posterior vitreous detachment resulting from posterior chamber phakic intraocular lens implantation

A 39-year-old woman presented with an early posterior vitreous detachment (PVD) after the implantation of an Implantable Collamer Lens phakic intraocular lens (pIOL). The patient detected PVD, noticing metamorphopsia early after surgery; it was confirmed with optical coherence tomography 5 days postoperatively. She was examined by a retinal expert, and no retinal tears were found. However, 15 days postoperatively, the patient had a retinal tear; 38 days later, a retinal detachment (RD) occurred despite treatment with argon laser photocoagulation. Prompt treatment and adequate patient cooperation achieved a final good uncorrected distance visual acuity (20/20). To our knowledge, this is the first description of the whole sequence involving early PVD leading to RD after pIOL implantation. This case highlights the importance of a fundus examination before and after surgery and of informing patients about the small chance of RD and visual symptoms.

Frequency of Retinal Redetachment after Cataract Surgery in Eyes with Previous Scleral Buckling Surgery

PURPOSE

To determine the cumulative risk and outcome of retinal redetachment after cataract surgery, in eyes with a history of retinal detachment repair by scleral buckling techniques.

DESIGN

Population-based, retrospective cohort study.

PARTICIPANTS

All phakic patients without previous ocular surgery or significant trauma who underwent scleral buckling surgery for rhegmatogenous retinal detachment between January 1, 2001, and December 31, 2010, at Norrlands University Hospital, Sweden (n = 537).

METHODS

International Classification of Diseases 10 diagnosis codes corresponding to rhegmatogenous retinal detachment were used to identify all cases. Medical charts of all patients identified were reviewed to confirm the diagnosis. Any recurrence of retinal detachment and the visual outcome in these cases were examined. The frequency of redetachment and the time span from cataract surgery to redetachment surgery were analyzed.

MAIN OUTCOME MEASURES

Any redetachment surgery after cataract surgery, best-corrected visual acuity (BCVA).

RESULTS

Three hundred and one (56%) male and 236 (44%) female patients were identified. During the follow-up period, 145 of 537 patients (27%) had phacoemulsification surgery, with a median time span of 3.4 years after the retinal detachment repair. Male patients had cataract surgery significantly more often (31% vs. 22%; P = 0.036), and at an earlier age, than female patients (65.6 vs. 69.4 years; P = 0.013). Recurrence of retinal detachment occurred in 3 patients (3/145; 2.1%), at 2.4, 3.9, and 6.9 years after cataract extraction, and their final BCVA was 20/70, 20/25, and 20/30, respectively. The cumulative percentage of redetachment surgery after phacoemulsification was 1% up to 10 years after the scleral buckling surgery, as calculated by life table analyses. Ten years after cataract surgery, the cumulative percentage of redetachment surgery was 5% in eyes with previous scleral buckling surgery.

CONCLUSIONS

In patients with a history of previous scleral buckling surgery, the risk of redetachment after cataract surgery is low. In these patients, phacoemulsification can be performed safely and there is no need for extended postoperative attention. It is, however, important to inform all patients with previous retinal detachment surgery to seek prompt medical care if they experience symptoms of redetachment. This is important even several years after the cataract surgery was performed.

Occurrence rate of retinal detachment after small gauge vitrectomy for idiopathic epiretinal membrane

PurposeTo assess the occurrence rate of retinal detachment (RD) after small gauge vitrectomy for idiopathic epiretinal membrane (ERM).Patients and methodsRetrospective observational case series. The records of consecutive patients operated on for idiopathic ERM using small gauge pars plana vitrectomy between August 2012 and December 2014 with at least a 1-year follow-up were reviewed. All patients were contacted by phone to assess the occurrence of RD during the post-operative follow-up. The main outcome was the occurrence of RD. Patients who underwent surgery for senile cataract over the same period with at least a 1-year follow-up were also contacted by phone for comparison.ResultsTwo hundred and sixteen eyes of 212 patients who had undergone ERM surgery were included, with a mean follow-up of 892±211 days (216-1238). RD occurred in two eyes (0.92%). Over the same period, two RD occurred in the 203 eyes (0.98%) of 157 patients operated on for senile cataract in our department.ConclusionsThe occurrence of RD after 25-gauge vitrectomy for idiopathic ERM was <1%. Using small gauge sutureless vitrectomy systems has improved the safety of ERM surgery, with a RD rate similar to that observed after cataract surgery.

VITREOMACULAR ADHESION EVOLUTION WITH AGE IN HEALTHY HUMAN EYES

PURPOSE

To quantify the changes in vitreomacular interactions that occur with normal aging in normal eyes.

METHODS

Spectral domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering, Heidelberg, Germany) foveal scans of subjects with best corrected visual acuity better than 20/40 and no ocular pathology were included in the study. Each scan was analyzed to determine the status of vitreoretinal interface: complete vitreous adhesion, partial posterior vitreous detachment (PVD) with persistent vitreomacular adhesion (VMA), or complete PVD. Area of VMA was delineated using the Spectralis drawing tool and calculated in mm for each scan. Subjects, aged 10 years to 97 years, were divided into 9 age groups according to decade of life.

RESULTS

Five hundred and sixty-six SD-OCT scans were analyzed. Area of VMA (mm) decreased sigmoidally (R = 0.99) with each decade of life. With aging, percentage of PVD increased while percentage of complete adhesion decreased. Males were found to have significantly larger area of VMA (mm) compared with females in the fifth through eighth decades of life, P < 0.05.

CONCLUSION

Vitreomacular interface interactions throughout life are age and gender dependent. This adds to our current understanding of the normal aging process undergone by the vitreous, thereby providing assistance in the clinical differentiation between normal and pathologic vitreomacular interactions.

Evaluation of posterior vitreous detachment after uneventful phacoemulsification surgery by optical coherence tomography and ultrasonography

BACKGROUND

The aim was to investigate the effect of uneventful phacoemulsification on vitreoretinal interface evaluated by optical coherence tomography (OCT) and ultrasound.

METHODS

One hundred and fifty eyes were evaluated for the presence or absence of posterior vitreous detachment by ultrasound and OCT prior to cataract surgery. Only those eyes with intact vitreoretinal adhesion were included in the study. All patients underwent cataract surgery. At one month, three months and six months, all patients were assessed with OCT and ultrasound. The data were analysed for statistical significance.

RESULTS

The study was carried out on 30 of 31 patients with no posterior vitreous detachment. The mean age of patients was 62.63 ± 7.15 years (range 49 to 75 years) and 15 were female. Posterior vitreous detachment developed in 17 patients (56.66 per cent) at one month, 21 patients (70 per cent) at three months and 22 patients (73.33 per cent) at six months following the surgery. No complications or acute symptoms were detected associated with posterior vitreous detachment.

CONCLUSION

Vitreoretinal interface changes and vitreoretinal separations and progression of separation can be easily evaluated by OCT. The current study confirms that posterior vitreous detachment occurs commonly soon after cataract surgery.

Perioperative retina evaluation of the cataract surgery patient

PURPOSE OF REVIEW

To describe recent evidence regarding cataract surgery in patients with coexisting retinal disease, focusing on factors that are important to the perioperative evaluation and treatment of this patient population.

RECENT FINDINGS

Studies in patients with age-related macular degeneration have yielded good visual gains without progression of neovascular disease or increased need for intravitreal antivascular endothelial growth factor therapy. Uveitic patients similarly gain vision on average, and control of inflammation remains paramount. Perioperative treatment with intravitreal antivascular endothelial growth factor and corticosteroid help mitigate postoperative macular edema in patients with diabetic macular edema. Risk of retinal detachment is elevated postcataract surgery, but evidence regarding prophylactic treatment of peripheral retinal pathology is lacking. Intracameral antibiotics have reduced rates of postcataract surgery endophthalmitis in recent population-based retrospective studies.

SUMMARY

Favorable visual acuity outcomes are possible following cataract surgery in patients with retinal disease, including uveitis, diabetic macular edema, and age-related macular degeneration. Perioperative control of retinal disease activity is desired, but level 1 evidence to guide best practices regarding optimal timing and nature of perioperative treatment remains limited. Prevention of postoperative retinal detachment and endophthalmitis is deserving of additional study.