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What Causes Posterior Vitreous Detachment In Eyes After Cataract Surgery?

Posted on Thu, 30 Oct 2014

Question: At age 51, I had cataract surgery in my left eye. There were no risk factors prior to surgery and no complications during surgery. The day after surgery the surgeon told me the pain I felt during the procedure was due to the following: He said the instrument he used to inject the IOL was larger than the incision. Instead of enlarging the incision (which would require a stitch) he forced the large instrument into the small incision. The PVD is on the lateral side of my eye. The IOL was injected medially. Approximately 8 weeks later I developed a PVD in my left eye. The surgeons partner who diagnosed the PVD told me the pressure used to force the large instrument into my eye during surgery caused traction on the vitreous membrane resulting in the PVD. Do you agree with the cause of the PVD? I don't have any other eye issues. Please advise.

Answered by Dr. Dadapeer K (54 minutes later)

Brief Answer:
PVD can follow cataract surgery.

Detailed Answer:
Hello
Welcome to Health care magic.

I am Dr. DADAPEER K, an ophthalmologist and I answer health problems related to eye.

I reviewed your history. It seems from the history that following cataract surgery you have developed posterior vitreous detachment.

Posterior vitreous detachment is a common event and is seen because of vitreous liquefaction. It is seen commonly in people after the age of 50-60 years. By 75 years 75% of people will have posterior vitreous detachment.
The common predisposing causes are high refractive errors in the form of myopia, injury, surgery, inflammations of the eye.....
Cataract surgery itself can predispose to the development of posterior vitreous detachment.
Hence in your case either surgery itself or the force during injection of the intraocular lens would have caused posterior vitreous detachment.

Most of them will not cause any problem. However retinal examination is required once after posterior vitreous detachment to look for associated retinal tear. If present it can be treated by laser photocoagulation. Since in your case it seems like there is no retinal tear, hence no need to worry about posterior vitreous detachment.

Hope the information is helpful to you.
Do write back to me for further questions.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dadapeer K (42 hours later)

The Surgeon who performed the Cataract Surgery in my left eye was a Resident/trainee still developing his skills.

The Cataract Surgery in my right eye was performed by a skilled surgeon. My right eye is perfect with no complications after surgery.

Considering that fact; is it reasonable to conclude the PVD in my left eye was caused during surgery resulting from the excessive force used during injection of the IOL and the surgeons lack of skill as a trainee and not from organic causes?

Answered by Dr. Dadapeer K (10 minutes later)

Brief Answer:
Surgery can precipitate PVD.

Detailed Answer:
Hello
Thank you for the follow up question.

Excessive manipulation during surgery or inflammation following surgery or age related changes in the vitreous all can cause posterior vitreous detachment.
In fact surgery and inflammation and other causes can finally precipitate an attack of posterior vitreous detachment if the vitreous is already partly or totally liquified.
It cannot be predicted that only surgery and its complications can cause posterior vitreous detachment until unless there exists some amount of vitreous degeneration in the form of liquefaction.

The same thing can be correctly told in this way that, surgery and or inflammation following surgery have precipitated and caused posterior vitreous detachment.

So surgery and or inflammation following surgery is an additive effect over and above the vitreous degeneration for precipitation of PVD.

Hope the information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dadapeer K (49 minutes later)

I understand the combined effect of surgery, inflammation and vitreous degeneration can result in a PVD. However, vitreous degeneration is speculative based on age and doesn't factually explain the difference in surgical outcomes between my right and left eyes using different surgeons and the effect of the excessive force used injecting the IOL into my left eye. Please elaborate.

Answered by Dr. Dadapeer K (42 minutes later)

Brief Answer:
Results of surgery depend on the skill of surgeon.

Detailed Answer:
Hello
Thank you for the follow up question.

The surgical outcomes definitely depends on the skill and expertise of the surgeon. Carefully done cataract surgery by a expert with minimum trauma will provide good results.
More force during cataract surgery will cause more inflammation and naturally will affect the post operative result also.

Hence this may be the reason for the fact that you are having problem only in left eye and not in the other eye.

Hope the information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dadapeer K (48 minutes later)

With no evidence of vitreous liquefaction; can excessive force used to inject an IOL increase eye pressure and cause traction on the vitreous membrane resulting in a PVD?

Answered by Dr. Dadapeer K (3 hours later)

Brief Answer:
Excessive force alone may not directly cause PVD.

Detailed Answer:
Hello
Thank you for the follow up question.

Excessive force used to inject an IOL can cause pressure over the vitreous but it will not cause traction over the vitreous.
Vitreous traction occurs because of intraoperative complications like posterior capsular tear and vitreous loss. This complications will also cause early onset of PVD.

But in the absence of intraoperative complications as I have mentioned above excessive force alone will not directly result in PVD.

Hope the information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dadapeer K (23 hours later)

Since I must have some amount of vitreous liquefaction in both eyes it appears based on your collective responses that the lack of skill and experience of the surgeon was the reason for the PVD. Clearly, because of a lack of skill and experience he used excessive manipulation during surgery and excessive force injecting the IOL causing greater inflammation and greater surgical trauma resulting in the PVD. Both eyes must have similar vitreous liquefaction so the greater skill and experience of the surgeon who treated my right eye resulted in a better surgical outcome. Do I properly understand your collective responses? Is posterior capsulotomy ever used to correct a PVD?

Answered by Dr. Dadapeer K (2 hours later)

Brief Answer:
Posterior capsulotomy is done for after cataract.

Detailed Answer:
Hello
Thank you for the follow up.

Yes you are correct in understanding the mechanism of posterior vitreous detachment. It results as a result of combined effect of all the factors.

Posterior capsultomy is used to correct posterior capsular opacification/ after cataract which develops after cataract surgery. It is not used to treat PVD.

Hope the information is helpful to you and I have answered your questions.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar