The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes☆

Abstract 

Purpose

To evaluate the rate of increase in nuclear sclerosis and posterior subcapsular cataracts in eyes as a function of patient age and use of intravitreal gas at the time of vitrectomy.

Design

Observational case series.

Methods

Nuclear sclerosis and posterior subcapsular cataracts were evaluated as a function of patient age and use of intravitreal gas at vitrectomy.

Setting

A clinical practice.

Study population

The study population consisted of 301 consecutive eyes.

Observational procedure

Nuclear sclerotic cataracts and posterior subcapsular cataracts were graded on a scale from 0 to 4.0 before and after vitrectomy.

Main outcome measure

Linear regression analysis was performed to measure and compare the rate of change in cataract score over time based on patient age and use of intraocular gas.

Results

Nuclear sclerotic cataracts showed minimal increase in patients younger than 50 years of age after vitrectomy (0.13 grades/year). Nuclear sclerotic cataracts increased at a rate of 0.7 to 0.9 grades/year (mean, 0.812) in patients aged 50 to 60 years, 60 to 70 years, 70 to 80 years, and 80+ years, even though the baseline nuclear sclerosis scores were progressively greater for each decade. The increase in nuclear sclerotic cataracts in patients younger than 50 years of age was significantly less (P < .001) than in patients aged 50 years or older. Eyes with intraocular gas use had a higher rate of nuclear sclerosis progression (0.8 grades/year) compared with eyes without intraocular gas bubbles (0.5 grades/year; P < .001). Posterior subcapsular cataract scores showed minimal or no increases in all groups.

Conclusions

Patients older than 50 years of age have a similar rate of increase in nuclear sclerotic cataracts, independent of age. The rate is approximately sixfold greater than in patients younger than 50 years of age. Intravitreal gas bubbles are associated with a nuclear sclerosis increase of approximately 60% compared with eyes without use of a gas bubble.