Vitrectomia Via Pars Plana para o Tratamento de Complicações Associadas à Facoemulsificação: Indicações, Timing e Técnica Cirúrgica
DOI:
https://doi.org/10.48560/rspo.27100Palavras-chave:
Facoemulsificação, VitrectomiaResumo
A facoemulsificação é um procedimento com baixa taxa de complicações, sendo a rutura da cápsula posterior com queda de fragmentos de cristalino umas das complicações mais frequentes. No entanto, o facto de este ser o procedimento cirúrgico oftalmológico mais realizado em todo o mundo, resulta na alta prevalência destas complicações, com consequências potencialmente ameaçadoras da visão. A vitrectomia via pars plana (VPP) é o procedimento gold-standard para a remoção dos fragmentos. As indicações para a VPP, o tempo entre a facoemulsificação e a VPP e a técnica cirúrgica a ser utilizada são temas de grande controvérsia.
O nosso objetivo foi fazer uma revisão de estudos que avaliaram as indicações, o timing e a técnica cirúrgica a ser utilizada na VPP, de forma a otimizar a sua utilização nas complicações após facoemulsificação.
A pesquisa foi realizada na MEDLINE utilizando os termos MeSH “phacoemulsification” e “vitrectomy”, filtrados desde abril de 2011 até abril de 2021, obtendo 394 resultados dos quais 23 se relacionam com o objetivo desta revisão.
As indicações, o timing e a técnica cirúrgica da VPP após a facoemulsificação são decisões multifatoriais que dependem da disponibilidade do centro cirúrgico e do cirurgião vitreorretiniano. A decisão é também baseada no critério quanto à gravidade da complicação e na experiência do cirurgião em determinada técnica. O tamanho e a densidade dos fragmentos devem ser relatados de forma a facilitar a decisão. Existe uma tendência para melhores resultados com a VPP precoce (os primeiros 3 dias devem ser evitados, exceto quando realizada no mesmo tempo cirúrgico que a facoemulsificação). A VPP 23- e 25-gauge sem necessidade de sutura é vantajosa quando comparada com a 20-gauge, especialmente em doentes com glaucoma. Mais estudos e com maior amostra são necessários para otimizar o tratamento destas complicações.
Downloads
Referências
Albert D, Miller J, Azar D, Young LH. Albert and Jakobiec’s Principles and Practice of Ophthalmology. London: Springer; 2008.
Zafar S, Kamil Z, Bokhari SA, Shakir M. Visual outcome of pars plana vitrectomy for dropped nucleus after phacoemulsification. J Coll Physicians Surg Pak. 2012;22:367-70.
Pande M, Dabbs TR. Incidence of lens matter dislocation during phacoemulsification. J Cataract Refract Surg. 1996;22:737- 742. doi: 10.1016/s0886-3350(96)80313-0.
Smiddy WE, Flynn HW Jr, Kim JE. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. Ophthalmic Surg Lasers. 1996;27:856-61.
Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. J Cat- aract Refract Surg. 2006;32:1521-1526.
Epstein DL. Diagnosis and management of lens-induced glaucoma. Ophthalmology. 1982;89:227-230.
Grandinetti A, Suenaga D, Oliveira FM, Cruz KS, Meneguette L, Moreira LB. Results of pars plana vitrectomy after complicated phacoemulsification surgery. Arq Brasil Oftalmol. 2015;78:73-75.
Chan E, Mahroo OA, Spalton DJ. Complications of cataract surgery. Clin Exp Optom. 2010;93:379-89.
Schaal S, Barr CC. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. J Cataract Refract Surg. 2009;35:863-7.
Margherio RR, Margherio AR, Pendergast SD, Williams GA, Garretson BR, Strong LE, Trese MT, Cox MS, Hassan TS. Vitrectomy for retained lens fragments after phacoemulsification. Ophthalmology. 1997;104:1426-32.
Stenkula S, Byhr E, Crafoord S, Carlsson JO, Jemt M, Shanks F, Stenevi U. Tackling the “dropped nucleus”. Acta Ophthalmol Scand. 1998;76:220-3.
Stilma JS, Sluijs FA, Meurs JC, Mertens DA. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. J Cataract Refract Surg. 1997; 23:1177-82.
Romero-Aroca P, Fernández-Ballart J, Méndez-Marín I, Sal- vat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Clin Ophthalmol. 2007;1:505-12.
Emery JM, Wilhelmus KA, Rosenberg S. Complications of phacoemulsification. Ophthalmology. 1978;85:141-150.
Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. Ophthalmology. 1996;103:971-976.
Kapusta MA, Chen JC, Lam WC. Outcomes of dropped nucleus during phacoemulsification. Ophthalmology. 1996;103:1184-1187.
Chiu CS. 2013 update on the management of posterior capsular rupture during cataract surgery. Curr Opin Ophthalmol. 2014;25:26-34.
Karadag R, Aydin B. Management of the dropped nuclear fragments. London: BMJ Publishing Group; 2013.
Olokoba L, Islam T, Nahar N, Mahmoud A, Olokoba A. A 3-year review of the outcome of pars plana vitrectomy for dropped lens fragments after cataract surgery in a tertiary eye hospital in Dhaka, Bangladesh. Etiopian J Health Sci. 2017;27:427-432.
Ruiz-Moreno J, Barile S, Montero J. Phacoemulsification in the vitreous cavity for retained nuclear lens fragments. Eur J Ophthalmol. 2006;16:40-45.
Kwok AK, Li KK, Lai TY, Lam DS. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. Clin Exp Ophthalmol. 2002;30:399-403.
Monshizadeh R, Samiy N, Haimovici R. Management of re- tained intravitreal lens fragments after cataract surgery. Surv Ophthalmol. 1999;43:397-404.
Tommila P, Immonen I. Dislocated nuclear fragments after cataract surgery. Eye. 1995;9:437-441.
Allinson RW, Metrikin DC, Fante RG. Incidence of vitreous loss among third-year residents performing phacoemulsification. Ophthalmology. 1992;99:726-730.
Guzek JP, Holm M, Cotter JB, Cameron JA, Rademaker WJ, Wissinger DH, Tonjum AM, Sleeper LA. Risk factors for intra-operative complications in 1000 extracapsular cataract cases. Ophthalmology. 1987;94:461-466.
Aaberg TM Jr, Rubsamen PE, Flynn HW Jr, Chang S, Mieler WF, Smiddy WE. Giant retinal tear as a complication of attempted removal of intravitreal lens fragments during cataract surgery. Am J Ophthalmol. 1997;124:222-6.
Moisseiev E, Kinori M, Glovinsky Y, Loewenstein A, Moisseiev J, Barak A. Retained lens fragments: nucleus fragments are associated with worse prognosis than cortex or epinucleus fragments. Eur J Ophthalmol. 2011;21:741-747.
Ho LY, Doft BH, Wang L, Bunker CH. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Am J Ophthalmol. 2009;147:587-594.
Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. J Cataract Refract Surg. 2002;28:310-315.
Ryoo NK, Park C, Kim TW, Park KH, Lee JH, Woo SJ. Management of vitreal loss from posterior capsular rupture during cataract operation: posterior versus anterior vitrectomy. Retina. 2016;36:819-824.
Watts P, Hunter J, Bunce C. Vitrectomy and lensectomy in the management of posterior dislocation of lens fragments. J Cataract Refract Surg. 2000;26:832-7.
Orlin A, Parlitsis G, Chiu YL, D ́Amico DJ, Chan RV, Kiss S. A comparison of same setting versus delayed vitrectomy in the management of retained lens fragments after cataract surgery. Retina. 2014;34:1969-76.
Rofagha S, Bhisitkul RB. Management of retained lens fragments in complicated cataract surgery. Curr Opin Ophthal- mol. 2011;22:137-40.
Chan EW, Yang E, Eldeeb M, Bainbridge JM, Cruz L, Sullivan PS, Muqit MM, Charteris DG, Minihan M, Ezra E, Wickham L. Contemporary Outcomes and Prognostic Factors of 23-Gauge Vitrectomy for Retained Lens Fragments After Phacoemulsification. Am J Ophthalmol. 2020;219:271-283.
Paul L, Agarwal M, Singh S, Mayor R, Gupta C, Gujral GS. Surgical and visual outcomes of posterior dislocated lens fragments after cataract surgery during 5-years at a tertiary eye hospital of North India. Nepal J Ophthalmol. 2019;11:172-180
Colyer MH, Berinstein DM, Khan NJ, Weichel ED, Lai MM, Deegan WF, Katira RC, Phillips WB, Sanders RJ, Garfinkel RA. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Retina. 2011;31:1534-1540.
Scupola A, Abed E, Sammarco MG, Grimaldi G, Sasso P, Parrilla R, Traina S, Blasi MA. 25-Gauge Pars Plana Vitrectomy for Retained Lens Fragments in Complicated Cataract Surgery. Ophthalmologica. 2015;234:101-8.
Vanner EA, Stewart MW. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis. Am J Ophthalmol. 2011;152:345-357.
Tajunisah I, Reddy S. Dropped nucleus following phacoemulsification cataract surgery. Med J Ophthalmol. 2007;62:364.
Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Management of dislocated nuclear fragments after phacoemulsification. Am J Ophthalmol. 1991;112:535-539.
Bessant D, Sullivan P, Aylward G. The management of dislocated lens material after phacoemulsification. Eye. 1998;12:641-645.
Lu H, Jiang YR, Grabow HB. Managing a dropped nucleus during the phacoemulsification learning curve. J Cataract Refract Surg. 1999;25:447-450.
Yeo L, Charteris DG, Bunce C, Luthert PJ, Gregor ZJ. Retained intravitreal lens fragments after phacoemulsification: a clinicopathological correlation. Br J Ophthalmol. 1999;83:1135- 1138.
Wilkinson C, Green WR. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Ophthalmology. 2001;108:1633-1637.
Stewart MW. Management of retained lens fragments: can we improve? Am J Ophthalmol. 2007;144:445-446.
Yang CS, Lee FL, Hsu WM, Liu JH. Management of retained intravitreal lens fragments after phacoemulsification surgery. Ophthalmologica. 2002;216:192-197.
Scott IU, Flynn HW Jr, Smiddy WE, Murray TG, Moore JK, Lemus DR, Feuer WJ. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Ophthalmology. 2003;110:1567-1572.
Joondeph BC, Myint S, Joondeph HC. Positive vitreous cul- tures in eyes with retained lens fragments. Retina. 1999;19:354.
Lambrou FH Jr, Stewart MW. Management of dislocated lens fragments during phacoemulsification. Ophthalmology. 1992;99:1260-1262.
Gilliland GD, Hutton WL, Fuller DG. Retained intravitreal lens fragments after cataract surgery. Ophthalmology. 1992;99:1263-1269.
Merani R, Hunyor AP, Playfair TJ, Chang A, Gregory-Roberts J, Hunyor AB, Azar D, Cumming RG. Pars plana vitrectomy for the management of retained lens material after cataract surgery. Am J Ophthalmol. 2007;144:364-70.
Hansson LJ, Larsson Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. J Cataract Refract Surg. 2002;28:1007-11.
Ho SF, Zaman A. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. J Cataract Refract Surg. 2007;33:2106-10.
Baker PS, Spirn MJ, Chiang A, Regillo CD, Ho AC, Vander JF, Kaiser RS. 23-Gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. Am J Ophthalmol. 2011;152:624-7.
Tzamalis A, Symeonidis C, Brazitikou IP, Tzetzi D, Chalvatzis N, Androudi S, Brazitikos P. Sutureless clear corneal ultrasonic fragmentation for retained lens fragments: A Pilot Study. Retina. 2017;37:494-499.
Nagpal M, Wartikar S, Nagpal K. Comparison of clinical outcomes and wound dynamics of sclerotomy ports of 20, 25, and 23 gauge vitrectomy. Retina. 2009;29:225-31.
Ho LY, Walsh MK, Hassan TS. 25-Gauge pars plana vitrectomy for retained lens fragments. Retina. 2010;30:843-9.
Viebahn M, Buettner H. Perflurophenanthrene unsuitable for postoperative retinal tamponade. Am J Ophthalmol. 1994;118:124-126.
Berdahl JP, Jun B, DeStafeno J, Kim T. Comparison of a torsional handpiece through microincision versus standard clear corneal cataract wounds. J Cataract Refract Surg. 2008;34:2091-5.
Bozkurt E, Bayraktar S, Yazgan S, Cakir M, Cekic O, Erdogan H, Yilmaz OF. Comparison of conventional and torsional mode (OZil) phacoemulsification: randomized prospective clinical study. Eur J Ophthalmol. 2009;19:984-9.
Chiang A, Garg SJ, Alshareef RA, Pitcher JD 3rd, Hu AY, Spirn MJ, Hsu J, Lane RG, Regillo CD, Ho AC, Schwartz SD. Removal of posterior segment retained lens material using the OZil phacoemulsification handpiece versus Fragmatome during pars plana vitrectomy. Retina. 2012;32:2119-26.
Garg SJ, Lane RG. Pars plana torsional phacoemulsification for removal of retained lens material during pars plana vitrectomy. Retina. 2011;31:804-5.
Spirn MJ. Comparison of 25, 23 and 20-gauge vitrectomy. Curr Opin Ophthalmol. 2009;20:195-9.
Smiddy WE, Ibanez GV, Alfonso E, Flynn HW Jr. Surgical management of dislocated intraocular lenses. J Cataract Re- fract Surg. 1995;21:64-9.
Smiddy WE, Flynn HW Jr. Management of dislocated posterior chamber intraocular lenses. Ophthalmology. 1991;98:889-94.
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Direitos de Autor (c) 2022 Revista Sociedade Portuguesa de Oftalmologia
Este trabalho encontra-se publicado com a Creative Commons Atribuição-NãoComercial 4.0.
CC BY
Não se esqueça de fazer o download do ficheiro da Declaração de Responsabilidade Autoral e Autorização para Publicação e de Conflito de Interesses
O artigo apenas poderá ser submetido com esse dois documentos.
Para obter o ficheiro da Declaração de Responsabilidade Autoral, clique aqui
Para obter o ficheiro de Conflito de Interesses, clique aqui
