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Cataract Surgical Planning: Effect of Vitreoretinal Surgery on the Lens Zonules Identified by Ultrasound Biomicroscopy

Cataract Surgical Planning: Effect of Vitreoretinal Surgery on the Lens Zonules Identified by Ultrasound Biomicroscopy. Scott M. Walsman MD; Amy Shah; Suqin Guo* MD Correspondence to Suqin Guo*, MD Assistant Professor, Ophthalmology, The Institute of Ophthalmology and Visual Science,

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Cataract Surgical Planning: Effect of Vitreoretinal Surgery on the Lens Zonules Identified by Ultrasound Biomicroscopy

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  1. Cataract Surgical Planning: Effect of Vitreoretinal Surgery on the Lens Zonules Identified by Ultrasound Biomicroscopy Scott M. Walsman MD; Amy Shah; Suqin Guo* MD Correspondence to Suqin Guo*, MD Assistant Professor, Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School

  2. Purpose • To assess whether prior vitreoretinal surgeries change lens zonule integrity and anterior segment morphology by Ultrasound Biomicroscopy (UBM) analysis and whether this can aid in the planning of cataract surgery

  3. Material & Methods • Retrospective review • 13 eyes with prior vitreoretinal surgery • 8 eyes without prior surgery (control) • The criteria for choosing controls were patients with prior vitreoretinal surgery in one eye, with no previous ocular surgeries or trauma in the control eye.

  4. Material & Methods • Ultrasound biomicroscopy was used to obtain the following measurements • All UBM measurement were recorded at least in 4 quadrants • Lens Zonular integrity • Posterior Chamber depth • Iris-zonule distance • Anterior chamber depth

  5. Results • Abnormalities in lens zonular support where found in 7/13 (54%) of eyes with prior vitreoretinal surgery while in the control group 0/10 showed similar zonular disruption.  • The average posterior chamber depth for all quadrants in the vitreoretinal surgery groups was 0.597 versus 0.517 in the control group.

  6. Discussion • It has been shown that there is an increased incidence of both intraoperative and postoperative complications in patients with prior vitreoretinal surgeries who are undergoing cataract surgery. [1,2]

  7. Discussion • Our study found a deepening of the posterior chamber depth and iris zonule distance in prior surgical eyes. • Loose or absent zonules may cause instability of the lens and a deeper posterior chamber. • Our study found no difference in the anterior chamber depth in both groups

  8. Discussion--Take Away • The incision sites of previous vitreoretinal surgeries may correspond to the areas for loosened lens zonules and deepened posterior chamber. • Analysis of these parameters by UBM may assist the cataract surgeon in surgical planning especially at the positions of entry of vitreoretinal surgeries.

  9. Conclusion • Our study shows that UBM may be a useful tool in imaging zonular abnormalities that may have been caused by prior vitreoretinal surgery to the eye. • This anatomical information may be useful for surgical planning in cataract surgery.

  10. References: • Braunstein RE, Airiani S. Cataract surgery results after pars plana vitrectomy. Current opinion in Ophthalmology 2003; 14:150-154 • Pavlin CJ, Buys YM, Pathmanathan T. Imaging zonular abnormalities using ultrasound biomicroscopy. Arch Opthalmol 1998; 116:854-857.

  11. Acknowledgement • This study was supported in part by an unrestricted grant from Research to Prevent Blindness.

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