Purpose:
There are concerns about possible increased risk of rubeosis iridis and neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy (PDR) when cataract surgery is combined with pars plana vitrectomy (PPV).We found no cases that developed anterior segment neovascularisation in this study. This compares favourably with lower incidence (2%) of postoperative iris (NVI) and angle neovascularisation (NVA) when treated by combined surgery compared to vitrectomy alone (15%) as reported by other authors1.
Methods:
We retrospectively reviewed the records of 31 consecutive patients who had undergone PPV combined with phacoemulsification (PEA) and intraocular lens implant (IOL) for complications of PDR. Endolaser treatment was performed in all patients.All operations were performed by one surgeon (RR).We recorded the patient’s age, gender, pre and post-operative logmar vision, indication for surgery, complications and length of follow up.
Results:
Patients’ ages ranged from 27 to 78 years, with a mean age of 56 years. Twenty one of the patients were men and ten were women. Indication for combined surgery included recurrent or non-resolving vitreous hemorrhage in 21 eyes (70%) and vitreous hemorrhage with tractional retinal detachment (TRD) in remaining 10 eyes (30%).Retinal tears during membrane dissection were seen intraoperatively in 5 patients (16%) and port related break in 1 (3%). Posterior YAG capsulotomy was required in 9 (28%) patients. One patient (3%) developed post operative fibrinous uveitis. No patients developed NVI or fibrovascular ingrowth at the scleorostomy site. Late vitreous haemorrhage ocuured in 2 patients (6.5%) and resolved spontaneously. All patients had improved vision (see table). The mean follow-up period was 17 months (range: 2-36 months).
Conclusions:
We confirm that combined surgery for diabetics does not have a higher incidence of NVI/NVA.Combined surgery (PPV, PEA and IOL) is safe and effective and allows for a more rapid visual recovery due to the one step approach.
Keywords: neovascularization • diabetic retinopathy • vitreoretinal surgery