Purpose: To evaluate the tendency of refractive prediction error and to examine factors that affect the refractive changes after combined vitrectomy and cataract surgery. Methods: We retrospectively reviewed demographic and clinical data, including axial length, intraocular pressure (IOP), preoperative anterior chamber depth, target refraction, preoperative refraction, postoperative refraction, keratometry, and refractive prediction error (the difference between postoperative and target refraction) of a retinal detachment (RD) group (28 eyes) and an epiretinal membrane (ERM) group (82 eyes). Both groups underwent combined vitrectomy and cataract surgery. Results: The refractive prediction error with myopic shift was evident in total patients (-0.85 ± 0.85 D, p < 0.001), the RD group (-0.92 ± 1.13 D, p = 0.007), and the ERM group (-0.83 ± 0.78 D, p < 0.001). There was no significant difference between preoperative and postoperative keratometry in the two groups (p = 0.742 and 0.500, respectively). The preoperative IOP of the affected eye was significantly lower than that of the unaffected eye in the RD group (p = 0.012). In multivariate regression analysis, preoperative axial length was significantly correlated with the refractive prediction error in both the RD (β = 0.189, p = 0.036) and ERM (β = 0.689, p < 0.001) groups. Age, IOP, and preoperative visual acuity were not significantly associated with the refractive prediction error. Conclusions: A significant myopic shift was observed in the RD and ERM groups after combined vitrectomy and cataract surgery with gas tamponade. The preoperative axial length was significantly correlated with the refractive prediction error in both groups.
Purpose: To compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant (Ozurdex ® ) and bevacizumab monotherapy in eyes with treatment-naive diabetic macular edema. Methods: We retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (21 eyes, intravitreal bevacizumab [IVB] group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (20 eyes, intravitreal dexamethasone [IVD] group). Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed 1, 3, and 6 months after injection. Results: At 3 and 6 months, the IVD group showed a significant improvement in BCVA compared to the baseline. Only a slight improvement in BCVA was observed in the IVB group during the initial 3 months; however, significant improvement was evident at 6 months compared with the baseline. During the first 3 months, the IVD group showed significant improvement in CMT compared with the IVB group; at 1 month after the initial injection, the CMT was 264.39 ± 54.95 µm for the IVD group versus 349.00 ± 112.18 µm for the IVB group (p = 0.011). At 3 months, the CMT in the IVD group had improved significantly compared with that of the IVB group (p < 0.001). The average number of additional intravitreal injections during the 6-month follow-up was 0.45 and 1.15 for the IVD and IVB groups, respectively. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataracts developed by two grades or more during follow-up in phakic eyes. Conclusions: In patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in CMT during the initial 3 months and the combined treatment group had fewer additional intravitreal injections.
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