Phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients.

Abstract

BACKGROUND: The «gold standart» for surgical treatment of patients with proliferative diabetic retinopathy (PDR is vitreoretinal surgery. However, the question of the timing of the removal of primary cataract in this category of patients remains open.AIM: To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patientsMETHODS: 67 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsifi tion surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsifi tion performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity.RESULTS: Visual functions improved in 88.6% of cases in group 1, and in 68.7% in group 2.CONCLUSIONS: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.

Systematic review of the efficacy and safety of stage I or II IOL implantation in patients with diabetic retinopathy

“…Konovalova et al [ 16 ] conducted a prospective study of 67 patients (67 eyes) with diabetic retinopathy who underwent combined surgery of the anterior and posterior segments, including 35 patients in the Stage II IOL Implantation Group and 32 in the Stage I IOL Implantation Group. The patients were followed up for 6 months.…”

“…[ 14 , 17 ] Xu et al [ 15 ] found that stage II IOL implantation resulted in better postoperative visual acuity than stage I IOL implantation, which may be related to better recovery of the primary disease and stabilization of the eye’s refractive state during stage II IOL implantation. Konovalova et al [ 16 ] found that stage II IOL implantation had better postoperative visual acuity and fewer postoperative complications than stage I. Therefore, stage II IOL implantation is advocated.…”

“…Studies that did not meet the inclusion criteria were excluded after reading the full literature. Finally, 4 literature were included in this systematic review [14][15][16][17] (Fig. 1).…”