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Vitrectomy-phaco combination spurs myopic shift
J Cataract Refract Surg. 2008;34(10):1754-1760.
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Patients who underwent combined vitrectomy and cataract surgery experienced a higher myopic shift than those who underwent cataract surgery only.
A prospective, controlled clinical trial included 40 patients who underwent combined vitrectomy and phacoemulsification and 40 patients who had cataract removal only. The combined surgery group included 21 patients with epiretinal membranes and 19 with macular holes.
Combined surgery patients had induced myopia of about –0.4 D. Mean myopic refractive change was –0.52 D among patients with epiretinal membranes and –0.2 D among those with macular holes.
“As patients with epiretinal membranes and macular holes generally obtained good postoperative results, we think a postoperative refractive error of approximately –0.4 D, although not always clinically significant, is not trivial,” the study authors said.
A slightly hyperopic IOL is suggested for patients undergoing combined surgery.
Plan on about 0.4 D less IOL power when vitrectomy is combined. This is news because most of us figured we needed to add more power because the IOL sat further back after vitrectomy. In fact, the finding is surprising enough I would like at least a second study to confirm these findings before I change my practice because the findings are a little counterintuitive. So I have filed this away for now and will not change my practice until I see longer-term confirmation. Even retinal swelling, which is a common finding after surgery, should result in a hyperopic and not a myopic shift.
Randall J. Olson, MD
OSN Cataract Surgery
Section Member