A previous pars plana vitrectomy is easy to miss. It leaves little the patient thinks worth mentioning, the referral letter often does not carry it, and in an eye that has been quiet for years the sclerotomy sites are not what anyone is looking at.
So ask directly: has this eye had any operation other than this cataract, and was there ever a retinal problem? Then look — sclerotomy scars, a posterior capsule that behaves unusually, an unexpectedly deep anterior chamber during surgery. If the answer is yes, the consent conversation changes and the follow-up changes, because this eye's risk of postoperative macular oedema is several times the baseline.
And get a baseline macular OCT. In an eye you already know is at raised risk, the scan that makes the postoperative one interpretable is the one taken before you operate.
- Ask explicitly about previous eye surgery and any history of retinal detachment
- Look for sclerotomy scars before assuming a virgin eye
- Take a baseline macular OCT in any eye with prior vitrectomy
- Mention the raised macular oedema risk during consent, with a number
- Plan the postoperative review around the 30 to 90 day window where the oedema appeared
Why it matters
The history that most changes this eye's risk is the one least likely to be in the referral.
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