The effect of vitreous presentation during extracapsular cataract surgery on the postoperative visual acuity at one year

• Published in: American journal of ophthalmology 2004-10, Vol.138 (4), p.536-542
• Main Authors: Collins, Joseph F., Krol, William F., Kirk, Gail F., Gaster, Ronald N.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cataract Extraction; Cataracts; Diabetic retinopathy; Eye Diseases - complications; Eye surgery; Follow-Up Studies; Human rights; Humans; Informed consent; Intraoperative Complications; Lens diseases; Lens Implantation, Intraocular; Medical sciences; Ophthalmology; Patient satisfaction; Postoperative Period; Prospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Vision Disorders - etiology; Visual Acuity - physiology; Vitreous Body - pathology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2004.04.050

The purpose of this study was to determine the effects that vitreous presentation (VP) during extracapsular cataract surgery has on patients' 1-year postoperative vision. The study was a prospective, long-term, clinical trial. The study took place at 19 Department of Veterans Affairs medical centers. Patients having VP during cataract surgery and receiving a posterior chamber (PC) intraocular lens (IOL) (230 patients) were prospectively compared with a 5% random sample of nonvitreous presentation (NVP) cataract surgery patients (521 patients). Best-corrected visual acuity (BCVA) at 1 year was obtained by a masked, certified examiner. There was no statistical difference ( P = .089) between the VP patients receiving PC IOL and the NVP patients in percentage of patients having BCVA of 20/40 or better at 1 year (91.1% vs 94.9%). There were significantly more PC IOL VP patients than NVP patients with BCVA of 20/50 or worse at some time during the first postoperative year (21.6% vs 10.9%; P = .0003), significantly fewer with BCVA of 20/20 or better at 1 year (27.8% vs 38.8%; P = .013), and significantly more with cystoid macular edema (11.5% vs 3.6%; P = .0002), retinal detachment (4.3% vs 0.2%; P = .0002), and uveitis (3.4% vs 0.6%; P = .012). The NVP patients rated their vision as very good or excellent significantly more often than the VP patients (71% vs 58%; P = .025). Vitreous presentation during extracapsular cataract surgery leads to somewhat worse overall outcomes in patients, although the majority of patients with VP do reasonably well.