Clinically significant corneal astigmatism and pars plana vitrectomy.
OBJECTIVE
To report a rare and previously unappreciated potential wound-related complication of repeat pars plana vitrectomy (PPV) combined with anterior segment surgery.


METHODS
From a total of 135 patients who had undergone PPV over a period of 15 months, 7 patients were identified on the basis of a visually disabling degree of astigmatism persisting at 3 to 4 months following their surgery. These patients were retrospectively studied from the standpoint of the numbers and combination of procedures they had experienced. Videokeratoscopy was employed as an objective method of documenting the astigmatism.


RESULTS
The average astigmatism at the corneal plane in these 7 eyes was 4.5 diopters (D). In the 5 patients who required suture lysis for visual rehabilitation, the average corneal astigmatism was slightly greater than 5.0 D. In all cases, the astigmatism was a symmetric "bow-tie" pattern and was in the meridian corresponding to the superonasal and inferotemporal sclerotomies. All 5 of the patients requiring suture lysis had undergone repeat PPV through the same sclerotomies; all had their astigmatism reduced to an average of 1.5 D.


CONCLUSIONS
Visually disabling astigmatism present months after surgery is almost certainly a rare, wound-related complication of PPV, but remains a previously unappreciated possibility in eyes undergoing repeat procedures through the same sclerotomies. Videokeratoscopy provides a reliable and rapid method of detection, while suture lysis in the steep axis represents a simple remedy.
Slusher
M Madison
MM
Wake Forest University Eye Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1033, USA.
Ford
Jerry G
JG
Busbee
Brandon
B
D000368:Aged; D001251:Astigmatism / Q000175:diagnosis / Q000209:etiology*; D002387:Cataract Extraction; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012164:Retinal Diseases / Q000601:surgery; D012189:Retrospective Studies; D013536:Suture Techniques; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*