Pars Plicata Anterior Vitrectomy for Intraoperative Posterior Capsule Rupture: 18-Month Study
Narrative Responses:
Purpose
The purpose of this article is to demonstrate the feasibility of a surgical approach that uses pars plicata site for anterior vitrectomy during phacoemulsification procedure complicated by posterior capsule rupture (PCR) and residual cortical matter.
Methods
Single center, retrospective, interventional, non-comparative case series. 35 eyes of 35 patients with intraoperative PCR were treated. Retrospective analysis of medical records of a consecutive series of patients who underwent pars plicata anterior vitrectomy was reviewed. Corrected and Uncorrected distance visual acuity (CDVA, UDVA), Intraocular pressure (IOP), Intraoperative features, Early and Late postoperative complications and Ultrasound biomicroscopic (UBM) evaluation of sclerotomy site. The final visual outcome at 18 months was evaluated.
Results
At 18 months followup, the mean postoperative UDVA (Log MAR) was 0.49±0.26 (p<0.05) and CDVA (Log MAR) was 0.09±0.14. There was no significant change in the IOP (p>0.05). The mean central macular thickness was 192.5 ± 5.54 microns. The postoperative UBM image of the sclerotomy site at 8 weeks demonstrated no vitreous adhesion or incarceration. Intraoperative hyphema and postoperative uveitis was seen in 2 (5.7%) cases each which resolved with medications. Pigment dispersion was noticed in 2(5.7%) cases; no case of iatrogenic retinal break, retinal detachment or IOL decentration was reported.
Conclusion
This technique allows thorough clean-up of vitreous in the pupillary plane and anterior chamber, affords better access to the subincisional and retropupillary cortical remnant, does not run a risk of damaging the vitreous base and peripheral retina providing a significant visual outcome with a favorable complication rate.