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Combined and sequential procedures with phaco, vitrectomy yield similar results
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Surgery for idiopathic epiretinal membrane is equally effective when pars plana vitrectomy and cataract surgery are performed sequentially or in combination, according to a study. However, the authors highlighted some differences they found in the follow-up according to the strategy adopted.
Sixty-two eyes of 62 patients with idiopathic epiretinal membrane were included, of which 20 underwent combined phacovitrectomy (COMBI group), 23 underwent sequential surgery with phacoemulsification first (CAT group) and 19 underwent sequential surgery with PPV first (VIT group). Vitrectomy was performed with a 23-gauge three-port procedure. The interval between procedures in the sequential groups was 4 to 6 weeks. In combined procedures, cataract surgery was performed before PPV.
Postoperatively, the refractive error was myopic in all groups, but was statistically significant only in the CAT group at 3 months and decreased during the follow-up period in all groups. Best corrected visual acuity improved significantly in all groups, but a greater improvement was seen in the COMBI group while the CAT group had a slight decline of six ETDRS letters at 2 to 4 weeks after cataract surgery.
Central subfield macular thickness and macular volume decreased in all groups but was greater in the COMBI group, consistent with greater BCVA improvement. Cystoid macular edema occurred in 37% of the CAT group, 5% of the VIT group and 10% of the COMBI group; the CAT and VIT groups each had one remaining case at 12 months.
Seventeen percent of the patients in the CAT group did not need PPV. This led the authors to conclude that although combined surgery obtained the most favorable outcome, “it seems reasonable to recommend starting with cataract surgery in cases with coexisting cataract in order to avoid unnecessary vitreoretinal surgery.” – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
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