Cataract surgery in post-vitrectomized eyes: development of posterior capsule plaque-A clinico-pathological correlation

Session Details

Session Title: Cataract Surgery Special Cases II

Session Date/Time: Monday 15/09/2014 | 16:30-18:30

Paper Time: 18:04

Venue: Auditorium

First Author: : S.Sahu INDIA

Co Author(s): :    G. Shah   S. Basu   R. Mittal        

Abstract Details

Purpose:

To analyse the development of posterior capsule plaque in post vitrectomized eye. The surgical technique, post operative outcome were also evaluated. Histopathological evaluation and grading of the posterior capsule plaque were also studied.

Setting:

L V Prasad Eye Institute, Bhubaneswar, Odisha, India

Methods:

A retrospective analysis of 33 post vitrectomized eyes that underwent cataract surgery by a single surgeon from July 2011 to June 2013 was done. Seventeen of the 33 had posterior capsular plaque (PC plaque) which were taken as GROUP 1 and 16 patients had no PC plaques were considered as GROUP 2. Routine manual small incision cataract surgery or Phacoemulsification done for cataract extraction .Posterior capsule plaque when seen was removed by a peeling technique. At first an edge of the plaque was lifted using a sinskey hook and held with paediatric forceps and was removed by peeling off from the posterior capsule. It was then mounted in formalin. An intraocular lens placed in the bag at the end of procedure. If a rent was seen the lens was placed in sulcus/bag which ever was suitable. The sample was put in buffered formaldehyde 4% and sent for histological examination. Serial slides were made from the samples and embedded in paraffin. Besides hematoxylin– eosin, masson’s trichrome staining were used to demonstrate the collagen fibres. The histological slides were photographed for documentation with image j software. Kruskal –Wallis test and spearman correlation tests were used for statistical analysis.

Results:

: Mean age of patients in group 1 and group 2 were (36.94+/-15.68) (47.19+/-13.44) years respectively. PC plaque development was significantly associated with silicon oil use. It was 94.12 %(n=16) and 43.75%(n=7) in group 1 and 2 respectively(p=0.0005.) Mean time of need for cataract surgery in post vitrectomized eyes was not significantly different between both groups.( Group 1- 9.4 +/-8.1 , group 2 - 8.3+/-5.8 months (p>0.5)).Pre cataract surgery best corrected visual acuity in group 1 was 1.95+/-0.71 log MAR which improved to 0.94+/-0.5 and in group 2 it was 1.32+/-0.63 which improved to 0.71+/-0.58. Removal of PC plaque was easier at six months but two of seven tissues were too small for histopathological evaluation .PC rent occurred in three of the seven during plaque removal in patients who were operated for retinal surgeries 6 to 12 months prior to cataract. On histological evaluation, based on cellular count per high power field, four were in early phase, nine in transition phase and four in late phase. Eleven of group 1 developed posterior capsule opacity (PCO) at (1.4 +/- 0.6) months and 5 required YAG capsulotomy. In group 2 only one patient developed significant PCO at 15 months requiring YAG capsulotomy.

Conclusions:

Cataract develops mostly within a year of vitreo-retinal surgeries .Posterior capsule plaques were frequently found in post vitrectomised eyes especially where silicon oil was used. It was safe to remove PC plaques in case of early cellular stage or in the late fibrotic stage.PCO developed significantly and earlier in patients with PC plaques in post vitrectomized eyes. Frequent follow up and Nd YAG capsulotomy helps to regain vision.

Financial Interest:

NONE