Vitreous Incarceration Complicating Cataract Surgery: A Light and Electron Microscopic Study

Vitreous incarceration in the cataract wound may contribute to development of aphakic cystoid macular edema, vitreoretinal traction and retinal detachment, and corneal decompensation. Thirty-one eyes in which vitreous was incarcerated in the cataract wound were examined postmortem and the corneal, anterior segment, and vitreoretinal changes were reported. Light and electron microscopy specimens demonstrated migration of corneal endothelium onto the adherent vitreous with production of basement membrane (descemetization). Fibrous ingrowth was present in 84% of the eyes. Iridovitreal synechiae were seen in 87% of the eyes. Cystoid macular edema, present in six eyes (19%), was usually accompanied by retinal phlebitis and often by distortion of the pars plicata. Vitreoretinal traction was seen in four eyes (13%), retinal tears were seen in two eyes (6%), and one eye had a total retinal detachment. Preretinal membranes were present in five eyes (16%) without other macular pathology. Persistent cystoid macular edema appears to occur in a minority of eyes with vitreous incarcerated in the cataract wound. If a vitrectomy is to be performed, the surgeon should excise vitreous adherent to the iris and in the anterior vitreous cavity in addition to the vitreous in the region of the wound.