Corneal epithelial defects following vitrectomy surgery with hand held versus sew on vitrectomy lenses

Purpose: Cornea! epithelial defects often occur during otherwise uncomplicated vitrectomy surgery. They result from accidental surgical trauma to the epithelium or intraoperative removal of the epithelium to improve the view of the fundus. The purpose of this study was to determine if there is a higher incidence of epithelial defects using hand held (HH) infusion lenses such as the Charles lens versus sew on (SO) lenses such as the Landers ring lenses. Methods: 211 consecutive vitrectomy cases performed by one author (JAK) were retrospectively reviewed. Complete data were available for 89 cases using HH lenses and 76 cases using SO lenses. The presence and duration of epithelial defects were determined, as well as pre-existing medical conditions, prior ocular surgery or trauma, and operative time. Statistical significance was determined by the x and student's t test where appropriate. Results : There were corneal epithelial defects noted postoperatively in 22/89 (24.7%) eyes with HH lenses and 7/76 (9.2%) eyes with SO lenses (p < 0-025). Of these defects, 11/22 (50%) of the HH group and 2/7 (28.6%) of the SO group were healed by the one week post-operative visit. Cases with epithelial defects were significantly longer (162.8 min) than cases where the epithelium remained intact (126.5 min) (p < 0.001). Conclu t ions: Corneal epithelial defects are a relatively frequent complication of vitrectomy surgery, and are more frequent in cases using HH lenses compared to SO lenses, and in longer cases compared to shorter ones. In our series, these defects were a significant cause of morbidity, as 15/29 (55%) persisted for longer than one week. Our data suggest that the incidence of corneal epithelial defects during vitrectomy surgery may be reduced by using SO lenses as well as reducing operative time.

Duke Scholars

Author Harbax (Tina) Kaur Singh Ophthalmology, Comprehensive Ophthalmology