Outcomes of Primary ACIOL Placement Versus Aphakia After Vitreous Loss in Resident Cataract Extractions
To compare the postoperative outcomes of resident-level cataract surgery complicated by vitreous loss in patients requiring either primary aphakia or an anterior chamber intraocular lens (ACIOL).
A single institution retrospective chart review was performed on patients who underwent cataract extraction by a senior resident complicated by vitreous loss between January 1, 2009 and December 31, 2013, who either had an ACIOL placed (n=35) at the time of surgery or were left aphakic (n=14). Patients who underwent planned primary vitrectomy were excluded, as were patients who were lost to follow-up earlier than 1 month. Primary outcomes were rates of post-operative complications (chronic uveitis, cystoid macular edema, increased intraocular pressure, retinal detachment). Secondary outcomes included final visual acuity and the rate of pars plana vitrectomy.
Thirty-five eyes underwent primary ACIOL implantation, and 14 eyes were left aphakic. Four aphakics (33%) had diabetes as compared to 2 in the ACIOL group (7.1%, p = 0.05). The ACIOL group had a higher rate of postoperative complications as compared to the aphakic group (57.1% ACIOL, 8.3% aphakic, p =0.005). The rate of retained lens material was higher in the aphakic group (17.8% ACIOL vs. 66.7% aphakic, p=0.008), as was the rate of pars-plana vitrectomy (14.3% ACIOL vs. 58.3% aphakic, p=0.008). Final visual acuity was logmar 0.7 in the aphakia group, and 0.9 in the ACIOL group.
In the setting of unplanned loss of capsular integrity at the time of cataract extraction during resident surgery at a single institution, primary aphakia is associated with fewer postoperative complications and improved final best corrected visual acuity as compared to anterior chamber intraocular lens implantation.