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Christiane Isolde Falkner-Radler, Susanne Binder; Refractive Outcome after Combined Microincision Cataract Surgery and 23-Gauge Vitrectomy.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2344.
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To evaluate preoperative biometry and outcomes after combined microincision cataract surgery and 23-gauge vitrectomy in a prospective clinical trial.
Inclusion criteria were defined as (a) patients presenting with vitreoretinal disorders and coexisting significant cataract, (b) the need for combined unilateral surgery, (c) the use of the IOL Master for preoperative lens calculation; and (d) the implantation of the iSERT preloaded 250/251 intraocular lens (IOL). Exclusion criteria were (a) the need for silicone oil tamponade; (b) diabetic vitreous hemorrhage and significant diabetic macular edema; (c) full-thickness macular holes, (d) posterior subcapsular and mature cataract; (e) myopia and hypermetropia of more than 5 diopters; (f) astigmatism of more than 2 diopters; (g) previous laser refractive surgery; (h) previous buckle surgery; and (i) pseudophakia on the non-study eye. Main outcome measure was the IOL power prediction error (PE). Cofactor analysis included intraocular pressure (IOP), best corrected visual acuity functional (BCVA) and anatomical outcomes and complication rates. For statistical analysis a regression model was used.
Thirty seven patients with a mean age of 70 years were evaluated. The vitreoretinal diagnosis was epiretinal membrane in 29 eyes, lamellar macular hole in 7 eyes and asteroid hyalosis in one patient. In 24 eyes an intraocular air or gas tamponade was used. The mean final IOL power PE was 0,23 diopters, ranging from +1.78 to -1.40. Baseline BCVA was 0,60 logMAR and improved to 0,15 logMAR at the 3 months follow-up, IOP was 17.0 mmHG before surgery and 16.5 mmHG at the last follow-up. Complication rates included a mild postoperative vitreous hemorrhage in one patient, a postoperative hypotony, which stabilized after air injection, in another patient. An IOL dislocation in one patient required repositioning after surgery. In 3 patients the sclerotomies were sutured.
Our first results suggest good and stable refractive results after this combined surgical approach including promising anatomic and functional results. The use of an intraocular tamponade seems to induce a slight hyperopic shift after this combined surgical approach.
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