Vitreous Prolapse: Treacherous After Effects of Cataract Surgery

Saptaparna Dasgupta, Bennett University

Cataract surgery involves the removal of the eye’s lens and, in most circumstances, the replacement of the lens with a synthetic lens. The eye’s lens is usually clear, but as a result of a cataract, the lens becomes hazy, affecting vision over time. Vitreous prolapse is described as the vitreous moving into the anterior section of the eye. During cataract surgery, the vitreous gel may prolapse into the anterior chamber due to a rupture of the posterior capsule.

A recent study published in the journal Scientific Reports by Kim et al. 2021 aims at exploring the etiology and clinical characteristics of delayed vitreous prolapse. Also, the surgical and visual results over the long term were recorded after the cataract surgery. Data from two hospitals between December 2006 and June 2020 was retrospectively evaluated in consecutive patients with vitreous prolapse.

Vitreous prolapse:

It causes the vitreous gel to push away from its normal position behind the posterior capsule and into the anterior portion of the eye. Previous research has indicated that the incidence of vitreous loss during cataract surgery ranges from 1.4 to 3.2 percent, and 7.65 percent for learning surgeons. But no studies have examined the frequency of delayed vitreous loss long after the initial surgery has been performed. Ophthalmological consequences of vitreous prolapse include pupillary block glaucoma with elevated intraocular pressure (IOP) and corneal decompensation resulting in several issues. The issues include bullous keratopathy, cystoid macular edema, uveitis, or retinal detachment at times.

The Study:

The study included patients suffering from vitreous prolapse, that has occurred post three months of the cataract surgery. The data of all the patients were evaluated considering demographic, clinical and the ocular features. The endothelial cell counts (cells/mm²) were also measured using specular microscopy. Also, the central macular thickness and intraretinal fluid were also analyzed using optical coherence tomography.

Surgery was performed by retinal specialists and a standardized three-port-vitrectomy was conducted using a 25-gauge system. Following certain specialized procedures, the specialists removed the vitreous completely at the time of vitrectomy procedure. The primary outcomes were obtained on the basis of the ophthalmological events which further triggers the delay of vitreous prolapse. On the other hand, the secondary outcomes were associated with long-term corrected distance visual acuity, intravascular pressure, etc., after the treatment (in Fig 1.).

Result obtained from the study:

179 cases of vitreous prolapse that occurred intraoperatively or shortly after cataract surgery were eliminated from the study’s 199 cases of the condition. Twenty eyes were included from 20 (10%) individuals with delayed prolapse who satisfied the inclusion criteria. The most frequent symptom among the 20 individuals was a hazy vision. Five patients (25%) had symptoms following YAG laser capsulotomy, and three (15%) had previously undergone surgery to implant an intraocular lens (IOL) in the ciliary sulcus due to intraoperative posterior capsular tears. In six pseudophakia patients (30%) with ostensibly intact posterior capsules, the etiology of vitreous prolapse was unclear.

After YAG laser capsulotomy, almost a quarter of our patients suffered a symptomatic vitreous loss. Over 15% of the patients had previously experienced a posterior capsular rupture during surgery. The surgical therapy improved vision, symptoms, and IOP in a substantial and long-term way. Every single individual of the total 20 patients had their prolapsed vitreous removed surgically. This was done either by anterior vitrectomy (62.0%) or pars plana vitrectomy (38.0%). None of the patients had recurring vitreous prolapse. After the vitreosarcoma was removed, the visual prognosis was good. Surgical therapy for vitreous prolapse relieved all visual pain without worsening it until the patients’ last appointment. Other clinics generally sent patients with delayed prolapse to their institution. Because the study was retrospective, it was limited in its ability to control all baseline variables.

Conclusion:

After cataract surgery, delayed vitreous prolapse can be induced by YAG laser capsulotomy or a history of posterior capsular tears.  Removing vitreous prolapse has positive long-term morphological and visual results, notably in the case of pars plana vitrectomy, with better visual acuity, IOP management, and decreased symptoms, as well as symptom relief. In case of  YAG laser capsulotomy, ophthalmologists should be mindful of the risk of vitreous prolapse and should treat it aggressively if it is discovered.

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References:

1. Kim, T. Y., Kang, H. G., Kim, C. Y., Koh, H. J., Kim, S. S., & Kim, M. (2021). Delayed vitreous prolapse after cataract surgery: Clinical features and surgical outcomes. Scientific Reports, 11(1), 16107. https://doi.org/10.1038/s41598-021-95527-0

2. Vitreous prolapse and loss. (n.d.). CRSToday.

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Author info:

Saptaparna Dasgupta, currently a B. Tech 3^rd year student, pursuing Biotechnology, is a diligent student and determined in terms of her career goals. Being a budding biotechnologist, she is open to all research fields of her course and passionate about knowledge. She is focused and constantly tries to improve her writing skills, also a project enthusiast and is fond of gaining the hands-on experience in laboratories. She believes that all hard works and efforts pays off eventually and follows this as the motto of her life.