Nonvitrectomizing vitreous surgery: a strategy to prevent postoperative nuclear sclerosis.

Abstract

The development or progression of postoperative nuclear sclerosis is the most common complication of successful vitrectomy in elderly patients. The authors treated idiopathic epimacular proliferation (EMP) with nonvitrectomizing vitreous surgery in an attempt to prevent postoperative nuclear sclerosis. Prospective, nonrandomized, comparative case series. The authors surgically removed membranes from the sensory retina in 21 eyes of 21 patients with EMP. Neither intravitreal infusion nor vitrectomy of any kind was performed during the procedure. The peeled membrane was left floating in the vitreous cavity in 11 (group 1) eyes and removed in 10 eyes (group 2). Nonoperated fellow eyes served as controls. Visual acuity, slit-lamp and/or Scheimpflug photography, and refractometry were performed pre- and postoperatively to evaluate changes in the degree of lenticular opacity. There was no difference in the rate of development or progression of nuclear sclerosis or the degree of myopic shift between operated and control eyes during the postoperative follow-up period (mean, 9.7 months). No serious complications were noted. There was no difference in postoperative course between patients in the two operative groups. Although interpretation of the results of this study is limited due to its small size and short follow-up, nonvitrectomizing vitreous surgery seems to decrease the postoperative development or progression of nuclear sclerosis in patients with idiopathic EMP.