EyeWorld India September 2018 Issue

ments should be performed within 3 weeks, although Dr. Rosen aims for surgery within 10 days, then considers a secondary IOL. A study on individuals with retained lens fragments who had pars plana vitrectomy showed that earlier surgery results in better visual outcomes. The median inter- val between cataract surgery and PPV was 12 days. Visual acuity was >20/40 in 29 (9%) patients preop- eratively and in 190 (56%) at last follow-up (p<0.001). Visual acuity was <20/200 in 224 patients (66%) preoperatively and in 67 (20%) at last follow-up (p<0.001). 1 A second, unrelated clinical trial corroborated these findings for visual recovery as well as the postoperative risk of uveitis, IOP rise, and retinal detachment. In the study’s late vitrectomy group, 66.6% of eyes developed persis- tent uveitis, 53.3% of eyes showed elevated IOP, and five eyes had retinal detachment. In the early PPV group, 16.6% developed uveitis and 20% showed elevated IOP, with only one eye having retinal detachment. The final visual acuity was 20±50 in early PPV and 20±200 in late PPV group. 2 Should a lens be implanted as a primary procedure? IOL implantation has to be careful- ly considered. Dr. Rosen said, “My view about primary IOL implanta- tion is that you need 240 degrees of capsule, at least, to support a three-piece IOL, otherwise you need to consider using an iris supported or anterior chamber IOL. If there is a significant amount of lens mate- rial in the vitreous cavity, and a vitrectomy is likely, a lens implant should not be inserted. EWAP References 1. Scott IU, et al. Clinical features and outcomes of pars plana vit- rectomy in patients with retained lens fragments. Ophthalmol. 2003;110:1567–72. 2. Salehi A, et al. Visual outcome of early and late pars plana vitrec- tomy in patients with dropped nu- cleus during phacoemulsification. J Res Med Sci. 2011;16:1422–9. Editors’ note: Dr. Rosen has no finan- cial interests related to this article. Contact information Rosen: phrosen@rocketmail.com EWAP CATARACT/IOL 39 September 2018