Combining cataract surgery with 25-gauge high-speed pars plana vitrectomy: A prospective study

Abstract

Purpose: To compare visual outcome and postoperative complications of combined 25-gauge pars plana vitrectomy and phacoemulsification with vitrectomy alone surgery in patients with epiretinal membrane and macular hole. Methods: A total of 110 eyes (73 eyes with epiretinal membrane and 37 eyes with macular hole) were enrolled in this prospective study. The eyes were divided into two groups: Group A included 55 eyes which underwent phacovitrectomy at the same time and Group B included 55 eyes which underwent vitrectomy alone. Follow-up visits were at 1, 3, and 6 months. Results: The best-corrected visual acuity correlation by analysis of variance measurement showed statistically non-significant differences between the two groups ( p = 0.32). The post hoc analysis from baseline, 1°, 2°, and 3° follow-ups was not statistically significant ( p > 0.05). The most common postoperative complication was cystoid macular edema that has been detected in 11 patients (10%) (seven eyes in Group A and four eyes in Group B): 2 patients (1.8%) developed a chronic macular edema. Intraocular hypertension occurred in five eyes (4.5%) (three in Group A and two in Group B). Four eyes (3.6%) underwent another surgical procedure for a persistent macular hole (two in Group A and two in Group B). The intraocular lens repositioning was performed one day after surgery in three eyes (2.7%) (Group A). The mean preoperative visual acuity was not different between the two groups ( p = 0.80). Conclusion: No significative differences between combined surgery and vitrectomy alone have been detected, in terms of postoperative complications and visual outcome.

Differences in Axial Length and IOL Power Based on Alternative A-Scan or Fellow-Eye Biometry in Macula-Off Rhegmatogenous Retinal Detachment Eyes

“…Due to postoperative complications involving the crystalline lens, more than half of phakic patients who underwent vitrectomy for RRD repair subsequently needed cataract surgery within 1 year [5]. Thus, combined phacovitrectomy was encouraged for patients aged 50 or older due to the lower cost of surgery, reduced complications and better visual outcome [6][7][8][9]. In 10-17% of cases of RRD with macular involvement, it was impossible to measure the axial length (AL) using optic biometry (IOLMaster) because of the limitations of the machine, such as dense media opacity, poor fixation by the patients or the lack of an available machine [10][11][12].…”

Microstructural Macular Changes after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment

“…In our study, patients who had undergone combined surgery showed a significantly higher CME prevalence during follow-up. Conversely, other studies have found no significant difference in CME prevalence between patients undergoing combined surgery and those undergoing PPV alone [17]. Some publications have speculated that the breakdown of the blood-aqueous-barrier due to cataract surgery, together with that of the blood-retinal barrier due to vitrectomy, could induce stronger ocular inflammatory responses in RRD eyes, leading to a higher reoperation rate after combined surgery than PPV alone [18]; however, this hypothesis is not widely confirmed by the literature.…”

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

“…In 2021, Savastano et al also published a prospective, comparative study involving 110 eyes with ERM or macular hole undergoing either PPV alone or combined phacovitrectomy. 28 The authors concluded there were no significant differences in visual outcomes and postoperative complications between the two group. Some studies suggest that phacovitrectomy may expedite visual recovery.…”