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Phacovitrectomy with foldable IOL improves visual acuity by three or more lines in most eyes
Acta Ophthalmol. 2009;87(8):896-900.
Phacoemulsification with adjunctive vitrectomy and foldable IOL implantation proved safe and effective in treating significant cataract and co-existing vitreoretinal abnormalities, according to a study.
"Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract," the study authors said.
The retrospective study included 186 eyes of 149 patients with visually significant cataract and various types of co-existing vitreoretinal diseases. Primary outcome measures were visual acuity, preoperative data, intraoperative complications and postoperative complications.
The primary indications for surgery were non-diabetic vitreous hemorrhage and proliferative diabetic retinopathy. Preoperative logMAR visual acuity ranged from 0.6 to light perception. Postoperative logMAR visual acuity ranged from 1.2 to no light perception.
After surgery, visual acuity improved by three or more lines in 162 eyes (87.1%). Visual acuity remained within three lines of preoperative values in 14 eyes (7.5%) and decreased in 10 eyes (5.3%).
Postoperative complications included elevated IOP, posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis and neovascular glaucoma, the authors said.
The authors retrospectively studied the outcomes of combined clear corneal cataract surgery with vitreoretinal surgery (pars plana vitrectomy, membrane peeling, photocoagulation, cryotherapy, diathermy, fluid-gas, oil-gas exchange, and gas or silicone injection). The majority of patients (87%) improved by three or more lines of vision, 7.5% remained within three lines of preoperative levels and 5.4% decreased in vision. The most common intraoperative complication was iatrogenic retinal hole creation during membrane peeling while the most common early postoperative complication was elevation of IOP. Development of posterior capsular opacity was the most common late complication. The authors conclude that combined phacoemulsification cataract extraction and vitreoretinal surgery offers better visualization and is safe in selected patients.
– Bonnie An Henderson, MD
OSN Cataract
Surgery Board Member