Combined Cataract Extraction and Vitrectomy for Macula-sparing Retinal Detachment: Visual Outcomes and Complications

Abstract

PurposeTo evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, and vitrectomy for macula-sparing rhegmatogenous retinal detachment.MethodsThe results of combined vitrectomy with cataract extraction were retrospectively analyzed in patients with preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must also have had macular sparing in a region 6,000 µm in diameter on optical coherence tomography. The anatomical success rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated.ResultsIn 56 patients followed postoperatively for more than 12 months, the initial and final surgical success rate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) had worse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases were comprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and two patients with cystoid macular edema. In the remaining 36 patients, there were no significant differences in visual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324).ConclusionsIn patients with cataracts who develop macula-sparing rhegmatogenous retinal detachment and whose visual prognosis is excellent assuming the retina can be reattached successfully, combined phacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However, the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes, posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods to prevent these postoperative complications.

Combined Pars Plana Vitrectomy, Phacoemulsification and Intraocular Lens Implantation: A review on the Advantages and Limitations of Phacovitrectomy

“…32 Kim et al performed a retrospective study involving 56 phakic patients with macula-sparing RD undergoing phacovitrectomy, which showed a 100% final surgical success rate for reattachment. 33 In 35.7% of patients, however, the postoperative visual acuity was worse than the preoperative visual acuity owing to ERM development (10.7%), posterior capsular opacification (21.4%) and CMO (3.6%). 33 In 2021, Tan et al demonstrated that eyes undergoing phacovitrectomy and PPV alone had an anatomic success rate of 84.3% and 89.2%, respectively.…”

“…33 In 35.7% of patients, however, the postoperative visual acuity was worse than the preoperative visual acuity owing to ERM development (10.7%), posterior capsular opacification (21.4%) and CMO (3.6%). 33 In 2021, Tan et al demonstrated that eyes undergoing phacovitrectomy and PPV alone had an anatomic success rate of 84.3% and 89.2%, respectively. 34 Despite good anatomic outcomes in cases of combined phacovitrectomy, visual outcomes may be limited by postoperative myopic surprise due to difficulty obtaining accurate, high-quality lens calculations.…”

Subconjunctival 0.1% epinephrine versus placebo in maintenance of mydriasis during vitrectomy: a randomized controlled trial

“…In addition to an extra corneal incision, the intracameral approach could result in further iris trauma and pupil miosis and instability of anterior chamber, especially when using contact lenses visualization systems. [ 4 , 5 ].…”