Dry 25-gauge vitrectomy to manage vitreous loss in phacoemulsification

Objective To investigate the efficacy and safety of dry anterior vitrectomy using a 25-Gauge (25-G) vitrectomy system in the management of vitreous loss associated with phacoemulsification. Methods This retrospective review was comprised of the records of 18 patients who underwent dry anterior vitrectomy using a 25-G vitrectomy system to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The group consisted of 18 eyes of 18 patients, 13 eyes with age-related cataract, 2 eyes with diabetic cataract,and 3 eyes with combined cataract. Patients ranged in age from 41 to 86 years [mean age (64.8±11.6)years]. All patients had ophthalmic examinations preoperatively, 1 day postoperatively and 3 to 7 days postoperatively. Topical anesthesia was used on 15 patients and paraocular anesthesia was used on 3patients. When finding vitreous prolapse into the anterior chamber, an anterior vitrectomy was performed with a 25-G vitrectomy system using a dry technique to clear the anterior chamber of vitreous. The 25-G vitrectomy system was set on the fastest cutting frequency, 1500 times/min, and suction was 250 mmHg. Intraocular lenses were implanted in the capsule or sulcus, and steroid eye drops were prescribed. The follow-up period was 3-13 months (average 4 months). Additional outcome measurements were best corrected visual acuity (BCVA), intraocular pressure, and postoperative complications. Results All procedures were uneventful and all intraocular lenses were primary implants. No intraoperative complications were attributed to the small-gauge instruments. Excluding 2 eyes with pre-existing conditions, 14 of 18 eyes (77.8%) had a final BCVA of 0.5 or better, and 38.9% (7/18) had a final BCVA of 1.0 or better. The other 2 patients with poor postoperative visual acuity were diagnosed with high myopia associated with pathologic change. Transient high intraocular pressure occurred in 4 eyes (22.2%) and was controlled with drugs and/or aqueous humor release in 3 days. Corneal edema was noted in 10 eyes (55.6%) during the first days postoperatively and all recovered in 7 days. Conclusion Dry anterior vitrectomy using a 25-G vitrectomy system is a safe, effective method to manage vitreous loss during phacoemulsification, and it leads to rapid visual recovery. Key words: Vitreous detachment;  Vitrectomy;  Phacoemulsification;  Lenses,intraocular