Complications associated with clear corneal cataract wounds during vitrectomy.

PURPOSE The purpose of this study was to report the intraoperative surgical complications that occurred during vitrectomy surgery associated with clear corneal incisions from previous cataract surgery. METHODS Retrospective, multicenter, case series, and chart review of five patients. RESULTS Five patients, 3 men and 2 women, with a median age of 75 years (range, 59-78 years), were followed up for a median of 7.5 months (range, 6 months to 5 years). In each eye, the patient had previously undergone cataract surgery and intraocular lens implantation through a clear corneal wound. Each patient developed a surgical complication during the subsequent vitrectomy related to leakage through the clear corneal wound. Vitrectomy was performed for retained lens fragments (three), macular hole (one), and repair of combined rhegmatogenous/tractional diabetic retinal detachment (one). Twenty-gauge vitrectomy was performed in 3 cases; 23-gauge in 1 case; and a combined 25- and 20-gauge vitrectomy was used in 1 case. Median time between cataract surgery and vitrectomy was 8 days (range, 0-14 days). Median preoperative visual acuity was 20/200 (20/50 to hand motions), and median postoperative visual acuity was hand motions (20/40 to light perception). In all five eyes, the clear corneal wound was found to leak extensively with minimal manipulation of the sclera at the pars plana. Leakage through clear corneal wounds occurred during marking of the sclerotomy site (Case 1), during placement of a 23-gauge infusion cannula (Case 2), during lens fragmentation (Case 3), during retinotomy and retinectomy (Case 4), and during scleral depression (Case 4). Four eyes developed choroidal detachment associated with hypotony caused by leakage through the clear corneal wound. Three of these eyes developed hemorrhagic choroidal detachment with subretinal and/or vitreous hemorrhage. One eye developed iris incarceration and anterior subluxation of a sulcus-placed intraocular lens associated with leakage through the clear corneal wound. In all five cases, extra sutures were placed to secure the clear corneal incision, and the cases were able to be completed. Two eyes underwent repeat vitrectomy to address complications associated with hemorrhagic choroidal detachments. Median final visual acuity was 20/400 (range, 20/40 to hand motions). The retina remained attached in all cases at the latest follow-up visit. CONCLUSION Intraoperative complications related to clear corneal incisions can occur during pars plana vitrectomy. We recommend that cataract surgeons encountering complications during surgery should secure clear corneal wounds in anticipation of eventual vitrectomy surgery. It is incumbent on the retinal surgeon to carefully inspect the corneal wound at the start of the vitrectomy procedure and to close it with sutures if it appears to leak with minimal manipulation. This should help to minimize additional intraoperative and/or long-term complications.