The Duke Eye Center is uncompromising with respect to their commitment to patient care and quality outcomes.  One of the most disturbing and sometimes devastating “let downs” that a patient and surgeon can experience after cataract surgery occurs in the patient who has undergone surgery that is perfect from a technical standpoint but in the healing process after surgery a vitreous floater and epimacular membrane develops.  While vitreous floaters are transient, an epimacular membrane’s impact can potential more disturbing and permanent.  Fortunately, the surgical options to correct this problem have greatly improved over the past several years.  To better understand this process after cataract surgery, the normal healing process routinely includes a more liquified vitreous gel that separates from the retina producing a floater and on occasion, the development of macular or foveal pathology, which may include an epimacular membrane.  In many cases, the membrane may even exist before the cataract surgery; however, the cataract made it difficult to identify during the preoperative examination.  In these cases, the membrane is identified after the cataract is removed, clearing the opacification and improving visibility of the posterior segment.  This membrane distorts central vision giving a blur or “waxy” character instead of clarity and is different from opacification of the posterior capsule that can be corrected with a YAG laser capsulotomy.  This change in vision is an additional concern for patients who have selected one of the so-called “Premium” intraocular lenses, costing more money and setting higher expectations.  The subgroup of “Premium” IOL patients who have selected a multifocal IOL (ReStor, Technis, ReZoom, Array) are at greater risk for frustration due to the mechanism and particularly if the IOL uses a diffractive mechanism to achieve near vision.   To help my colleagues and patients better understand this potential problem, I have reprinted the following abstract from the American Journal of Ophthalmology:

Incomplete Posterior Vitreous Detachment: Prevalence and Clinical Relevance

Purpose

To investigate the prevalence and clinical relevance of incomplete posterior vitreous detachment (PVD).

Design

Prospective, observational cohort study.

Methods

setting: Institutional. patients: Consecutive patients without previous ocular history who were diagnosed with acute uncomplicated PVD. observations: Baseline kinetic ultrasound evaluation differentiated posterior vitreous separation as complete or incomplete. Prospective follow-up searched for complications related to PVD. Multivariate analysis evaluated associations of baseline demographic and clinical characteristics to incomplete PVD. A Kaplan-Meier analysis evaluated the probability and its standard error of experiencing an adverse outcome. The log-rank test determined whether incomplete PVD modifies the natural history of PVD. main outcome measures: Prevalence of incomplete PVD and the estimated incidence of late adverse outcomes such as new retinal tears, epimacular membranes, or both.

Results

A total of 54 of 207 patients had incomplete PVD (prevalence, 26.1%). Younger age and lattice degeneration were associated independently with incomplete PVD. After a mean follow-up of 5 years (range, 4 to 8 years), 16 patients (9.7%) experienced some adverse outcome. In 5 patients (2.7%), new retinal tears and 1 retinal detachment developed. In 12 patients (7.6%), epimacular membranes developed. Patients with incomplete PVD at baseline experienced significantly more adverse outcomes than patients with complete PVD (Kaplan-Meier estimated probability and standard error, 19.2% and 0.061 vs 5.4% and 0.02; P = .01, log-rank test).

Conclusions

Up to one fourth of symptomatic, acute, and uncomplicated PVDs show incomplete posterior vitreous separation. Delayed complications related to PVD, like retinal tears and epimacular membranes, develop more frequently in patients showing incomplete PVD.