Comparison of Refractive Changes Following Pseudophakic Vitrectomy with or without Gas Tamponade

Year 2021, Volume: 4 Issue: 3, 252 - 256, 01.09.2021

Sami Yılmaz Ayşegül Mavi Yıldız Mehmet Emin Aslancı Remzi Avcı

https://doi.org/10.19127/bshealthscience.902131

Abstract

To compare refractive changes following 23-gauge (G) vitrectomy with or without gas tamponade in pseudophakic eyes. This retrospective study included patients with neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy, who underwent 23 G pars plana vitrectomy (PPV) between February 2015 and March 2019. Indications for surgery included; rhegmatogenous retinal detachment in Group 1 and epiretinal membrane or vitreous hemorrhage (VH) in Group 2. Gas tamponade 12% perflouropropane (C3F8) was used in Group 1 whereas no tamponade was used in Group 2. The minimum follow-up was 24 months for both groups. A total of 47 patients were recruited (Group 1, n=27 and Group 2, n=20). The visual acuity improvement was statistically significant in both groups (p<0.001). A statistically significant myopic shift was observed in both groups [-0.40±0.54 diopter (D) (P=0.001) in Group 1; -0.17±0.29 D (P=0.017) in Group 2]. In addition, a myopic shift greater than 1 D was observed in 2 eyes (7.4%) in Group 1. The significant hyperopic shift was detected in 3 eyes (11.1%) in Group 1 and 5 eyes (25%) in Group 2. Surgically induced astigmatism was similar between groups [0.46±0.25 D in Group 1 and 0.54±0.26 D in Group 2, (P=0.314)]. Postoperative complications included VH (n=1/27) and macular hole (n=1/27) in Group 1. The clinically significant myopic shift may occur following 23 G vitrectomy in pseudophakic eyes. Eyes with gas tamponade are more prone to myopic shift, possibly due to anterior movement of the intraocular lens. Therefore, targeting slight residual hyperopia (+0.50 D) might be suggested in patients with gas tamponade.

Keywords

Pars plana vitrectomy, Myopic shift, Induced astigmatism, Pseudophakic eyes, Gas tamponade

References

• Akinci A, Batman C, Zilelioglu O. 2008. Cataract surgery in previously vitrectomized eyes. Int J Clin Pract, 62: 770-775.
• Alio JL, Plaza-Puche AB, Férnandez-Buenaga R, Pikkel J, Maldonado M. 2017. Multifocal intraocular lenses: An Overview. Surv Ophthalmol, 62: 611-634.
• Byrne S, Ng J, Hildreth A, Danjoux JP, Steel DH. 2008. Refractive change following pseudophakic vitrectomy. BMC Ophthalmol, 8: 19.
• Campo RV, Sipperley JO, Sneed SR, Park DW, Dugel PU, Jacobsen J, Flindall RJ. 1999. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments. Ophthalmology, 106: 1811-1815.
• Citirik M, Batman C, Bicer T, Zilelioglu O. 2009. Keratometric alterations following the 25-gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Clin Exp Optom, 92: 416-420.
• Eckardt C. 2005. Transconjunctival suturless 23-gauge vitrectomy. Retina, 25: 208-211.
• Eğrilmez S, Dalkılıç G, Yağcı A. 2003. Astigmatizma analizinde vektöryel analiz programı. Türkiye Oftalmoloji Gazetesi, 33: 404-416.
• Fujii GY, De Juan E, Humayun MS, Pieramici DJ, Chang TS, Awh C, Ng E, Barnes A, Wu SL, Sommerville DN. 2002. The new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmol, 109: 1807-1812.
• Hamoudi H, Kofod M, La Cour M. 2013. Refractive change after vitrectomy for epiretinal membrane in pseudophakic eyes. Acta Ophthalmol, 91: 434-436.
• Hamoudi H, Christensen UC, La Cour M. 2017. Corneal endothelial cell loss and corneal biomechanical characteristics after two-step sequential or combined phaco-vitrectomy surgery for idiopathic epiretinal membrane. Acta Ophthalmol, 95: 493-497.
• Hasegawa Y, Okamoto F, Sugiura Y, Okamoto Y, Hiraoka T, Oshika T. 2014. Intraocular pressure elevation after vitrectomy for various vitreoretinal disorders. Eur J Ophthalmol, 24: 235-241.
• Ikeda T, Minami M, Nakamura K, Kida T, Fukumoto M, Sato T, Ishizaki E. 2014. Progression of nuclear sclerosis based on changes in refractive values after lens-sparing vitrectomy in proliferative diabetic retinopathy. Clin Ophthalmol, 8: 959-963.
• Jahn CE, Minich V, Moldaschel S, Stahl B, Jedelhauser P, Kremer G, Kron M. 2001. Epiretinal membranes after extracapsular cataract surgery (1). J Cataract Refract Surg, 27: 753-760.
• Machemer R, Buettner H, Norton EW, Parel JM. 1971. Vitrectomy: A pars plana approach. Trans Am Acad Ophthalmol Otolaryngol, 75: 813-820.
• Monteiro T, Soares A, Leite RD, Franqueira N, Faria-Correia F, Vaz F. 2018. Comparative study of induced changes in effective lens position and refraction after Nd:YAG laser capsulotomy according to intraocular lens design. Clin Ophthalmol, 12: 533-537.
• Muto T, Nishimura T, Yamaguchi T, Chikuda M, Machida S. 2017. Refractive changes after lens-sparing vitrectomy for macular hole and epiretinal membrane. Clin Ophthalmol, 11: 1527-1532.
• Okamoto Y, Okamoto F, Hiraoka T, Oshika T. 2014. Refractive changes after lens-sparing vitrectomy for rhegmatogenous retinal detachment. Am J Ophthalmol, 158: 544-549.
• Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. 2010. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology, 117: 93-102.
• Oztas Z, Palamar M, Afrashi F, Yagci A. 2015. The effects of Nd:YAG laser capsulotomy on anterior segment parameters in patients with posterior capsular opacification. Clin Exp Optom, 98: 168-171.
• Önder H. 2018. Nonparametric statistical methods used in biological experiments. BSJ Eng Sci, 1(1): 1-6.
• Parolini B, Prigione G, Romanelli F, Cereda MG, Sartore M, Pertile G. 2010. Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconjunctival pars plana vitrectomy with 1-year follow-up. Retina, 30: 107-111.
• Patterson JA, Ezra E, Gregor ZJ. 2001. Acute full-thickness macular hole after uncomplicated phacoemulsification cataract surgery. Am J Ophthalmol, 131: 799-800.
• Qureshi MH, Steel DHW. 2020. Retinal detachment following cataract phacoemulsification-a review of the literature. Eye (Lond), 34: 616-631.
• Rementeria-Capelo LA, Garcia-Pérez JL, Gros-Otero J, Morán A, Sánchez-Pina JM, Contreras I. 2020. Visual and refractive outcomes of cataract surgeries performed in one year in a private practice setting: Review of 2714 procedures. J Ophthalmol, 14: 2421816.
• Sebag J, Yee KMP, Nguyen JH, Nguyen-Cuu J. 2018. Long-term safety and efficacy of limited vitrectomy for vision degrading vitreopathy resulting from vitreous floaters. Ophthalmol Retina, 2: 881-887.
• Sharma YR, Karunanithi S, Azad RV, Vohra R, Pal N, Singh DV, Chandra P. 2005. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand, 83: 293-297.
• Shibata M, Oshitari T, Kajita F, Baba T, Sato E, Yamamoto S. 2012. Development of macular holes after rhegmatogenous retinal detachment repair in japanese patients. J Ophthalmol, 2012: 740591.
• Suzuki Y, Sakuraba T, Mizutani H, Matsuhashi H, Nakazawa M. 2000. Postoperative refractive error after simultaneous vitrectomy and cataract surgery. Ophthalmic Surg Lasers, 31:271-275.