Phaco plus vitrectomy a good option for older patients with vitreoretinal pathologies

Combining phacoemulsification with vitrectomy can be an effective management option for presbyopic patients who require vitreoretinal surgery, even if significant lens opacities are not present, according to a retrospective study.

R. Ling and colleagues at the Royal Devon and Exeter Hospital and the University of Plymouth in England reviewed the records of 90 consecutive presbyopic patients treated with the combined procedures for vitreoretinal pathologies.

The study included 21 patients with primary rhegmatogenous retinal detachment (RRD), seven with redo-RRD, 38 with stage 2 or 3 full thickness macular holes, six with stage 4 full thickness macular holes, 11 with idiopathic epiretinal membrane, three with proliferative diabetic retinopathy (PDR) and four with vitreous hemorrhage secondary to branch retinal vein occlusion.

No lens opacities were present in 84.5% of the patients.

Retinas were reattached following one combined procedure in 90.5% of the primary RRD patients and 71.4% of the redo-RRD patients, and final reattachment rates were 95.2% and 100% respectively in those groups.

Macular holes were closed postoperatively in 89.5% of the patients with stage 2 or 3 full thickness macular holes and in 83.3% of patients with stage 4 full thickness macular holes.

All patients had significant improvement in vision, from a mean preoperative logMAR visual acuity of 1 to a mean postop 0.48 (P < .001).

Posterior capsular opacification was the most common postop complication, developing in 51% of patients. Fibrinous uveitis developed in 13.3%, iris bombe in 2.2% and IOL/iris capture secondary to gas overfill in 1.1%.

The study is published in the November issue of the British Journal of Ophthalmology.