Sir,
We read with interest the article by Uhlmann and Wiedemann,1 and congratulate the authors on their encouraging initial results. We would be interested to know some further details of their results.
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1)
We note that during the follow-up period described none of the 14 eyes had any retinal problems postoperatively. We would be interested to know how many of these patients had a pre-existing posterior vitreous detachment (PVD) preoperatively and how many needed a PVD induced during vitrectomy. Inducing a PVD during surgery is a well-known risk factor for retinal tear formation and retinal detachment during vitrectomy. Conversely a pre-existing PVD would reduce the risk of these patients suffering retinal problems either with vitrectomy surgery or cataract surgery alone.
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2)
Combining cataract extraction with lens implantation and three port pars plana vitrectomy has been found to induce a myopic shift in the actual postoperative refraction from the predicted postoperative refraction.2, 3 Suzuki et al have reported a spread between predicted and actual refractions of −0.05±1.18 D in a combined surgery group and +0.55 ±/1.32 D in a cataract surgery alone group. We note that Uhlmann and Wiedemann1 found a mean postoperative refraction of −0.7±1.6 D. We would be interested to know whether there was any myopic shift in their study between the predicted and the actual refractions. This would be an important finding to be aware of in, what is primarily, a refractive procedure.
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3)
Shioya et al have also reported a difference in the postoperative refraction in patients having gas tamponade and those who did not have gas tamponade. In eyes without gas tamponade, the refractive error was +0.14±1.11 D as compared to the eyes with gas tamponade in whom the refractive error was −0.36±1.22 D. It was proposed that the gas tamponade pressed the intraocular lens forward and caused the myopic shift. We would be interested to know from the authors if any of their patients had gas tamponade following vitrectomy.
References
Uhlmann S, Wiedemann P . Refractive lens exchange combined with pars plana vitrectomy to correct high myopia. Eye; advance online publication, June 10, 2005; doi: 10.1038/sj.eye.6701933.
Suzuki Y, Sakuraba T, Mizutani H, Matsuhashi H, Nakazawa M . Postoperative refractive error after simultaneous vitrectomy and cataract surgery. Ophthalm Surg Lasers 2000; 31(4): 271–275.
Shioya M, Ogino N, Shinjo U . Change in postoperative refractive error when vitrectomy is added to Intraocular lens implantation. J Cataract Refract Surg 1997; 23(8): 1217–1220.
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Manvikar, S., Steel, D. Refractive lens exchange combined with pars plana vitrectomy to correct high myopia. Eye 20, 1399–1400 (2006). https://doi.org/10.1038/sj.eye.6702250
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DOI: https://doi.org/10.1038/sj.eye.6702250