We appreciate the opportunity to respond to the points raised by Carifi and colleagues regarding our paper on same-day vs later pars plana vitrectomy (PPV) for retained lens fragments after cataract surgery.
Regarding the inclusion of aphakic eyes, all visual acuities in this study were reported as best-corrected visual acuity (BCVA) before and after surgery. If these eyes underwent subsequent IOL implantation, the BCVA was then recorded.
In our study, information on the exact size of the fragment was inconsistently recorded in this retrospective chart review. Colyer and associates, however, identified the median sizes of the retained lens fragments and graded them on a scale: (1) cortical fragments only; (2) <½ nucleus; (3) >½ nucleus. It is not surprising that they noted a significant trend toward larger fragments’ being removed immediately and smaller fragments’ being removed at later times.
Similarly, data concerning the use of a fragmatome were not always recorded. In general, larger lens fragments and hard nuclei required the use of a fragmatome. Although it may seem intuitive to predict increased complication rates in cases where a fragmatome was used or the retained lens fragment was larger, the Colyer study did not demonstrate significant differences in visual-acuity outcomes or complication rates in same-day vs later PPV.
For the later intervention groups, the decision to pursue PPV for retained lens fragment removal was made by the individual treating physician rather than using a standardized protocol. The clinical indications for surgery most commonly included marked intraocular inflammation, elevated intraocular pressure, and poor visual acuity. The majority of these patients were receiving medical treatment prior to surgery with 45% and 50% of patients in the same week and later than 1-week group using pressure-lowering drops ( P = 0.36). Similarly, 64% and 81% in the same week and later than 1-week group were using topical steroids ( P = 0.001, Fisher exact test) (previously unpublished data).
Carifi and associates also inquired into the differences in follow-up time in the groups. Referencing Table 1 in the article, there was no significant difference in follow-up, with median time ranging from 6.5 months in the greater-than-1-week group to 10.5 months in eyes undergoing same-day PPV ( P = 0.23).
Finally, Carifi and associates state that our study “does not provide definitive evidence” for the timing of PPV. The goal of this study was not to provide definitive results but rather, to report our outcomes and complication rates over a 22-year study window.
There was no statistically significant difference in BCVA outcomes or rates of retinal detachment in the groups, but there was a trend toward less favorable outcomes in cases delayed beyond 1 week. Given these findings, and in the absence of a definitive randomized control trial, we believe that the timing of PPV for retained lens fragments allows for immediate or later intervention.