Posterior Vitreous Detachment Following Phacoemulsification Under Low Intraocular Pressure: A Population based OCT Study

Abstract

Purpose: To determine the prevalence and progression of posterior vitreous detachment (PVD) after phacoemulsification performed under standardized low-intraocular pressure (IOP) active fluidics with real-time surge mitigation, and to characterize age- and sex-specific PVD prevalence in the general population. Methods: An observational, retrospective, longitudinal cohort study was developed in a private ophthalmic clinic of Tandil city, Argentina. Records of patients aged ≥40 years with axial length 22–25 mm were reviewed. A single surgeon used the Centurion system (Alcon) with Active Fluidics and Active Sentry (30 mmHg infusion, 35 cc/min flow, 350 mmHg vacuum). Posterior vitreous status was staged with widefield spectral domain optical coherence tomography (SD-OCT) using Johnson’s classification. Eyes with prior ocular surgery, ocular disease, or intraoperative complications were excluded. Minimum follow-up was 12 months. Results: We analyzed 1984 eyes: 432 operated and 1552 controls. Complete PVD (stage 4) increased with age and was more frequent in women ≥60 years. After ≥12 months, most eyes remained stable. Progression to stage 4 occurred in 6.9% of eyes starting at stage 0, 19.7% at stage 1, 47.8% at stage 2, and 25.0% at stage 3. In men, no differences were found between operated and control eyes; in women, excess stage 4 appeared at ages 70–79 years (73.6% vs 62.3%, p<0.01). Conclusions: Under low-IOP active fluidics with surge mitigation, PVD progression follows biological factors (age, sex, baseline stage) rather than universal surgical acceleration. Widefield SD-OCT improves staging accuracy, and a pressure– time impulse model links fluidics dynamics to vitreoretinal traction.