Combined Cataract Extraction (CE) and Pars Plana Vitrectomy (PPV) for the Treatment of Visually Significant Cataract and Vitreo-Retinopathy in Patients With Diabetes Mellitus (DM)

Abstract

Purpose:: Visually significant cataract and severe vitreoretinopathy often arise concurrently in patients with DM. Although potential benefits to patient & physician may arise from addressing both issues during the same surgery, the outcome of such combined surgery in patients with DM is not fully understood. We examined functional & anatomical results as well as side effects & complications of combined CE/PPV.

Methods:: Retrospective chart review of 93 consecutive patients undergoing combined CE/PPV between 1/2003 & 10/2006 at Joslin Diabetes Center. PPV was performed by 1 surgeon & CE by 3 surgeons. ETDRS protocol VA & clinical retinopathy grading, retinal biomicroscopy & diagnostic tests were recorded preop and at last follow-up. All intra and postop complications were recorded.

Results:: 100 eyes of 93 patients were evaluated. 87 patients (94%) had DM. PPV indications were epiretinal membrane (8 eyes), ERM with macular edema (56), vitreous opacities (28), tractional retinal detachment (4), & macular hole (4; MH). All eyes had visually significant cataract. Mean age was 65y (range 42-84), 50% female, 53% type 2 DM, mean duration DM 27y (2-59) & mean HbA1c 7.8% (5.0-10.5). Mean follow-up was 8.5mo (median 5mo;range 1wk-32mo). Median initial and final BCVA was 20/80 and 20/50, respectively. Mean BCVA improvement was 2.1 lines and 49% gained 2 or more lines. Final BCVA was better in 70% of eyes (p<0.01), worse in 17% & within 3 letters in 13%. Preop, BCVA was 20/25, 20/40, 20/80 or 20/200 or better in 1%, 9%, 43% & 74%, respectively. Similar final BCVA postop was present in 19%, 37%, 63% & 82%. ERM was completely removed in 46 eyes (82%), macular edema resolved in 26 eyes (46%) & none of the MH were closed at last followup. Complications occurred in 13 eyes (5 transient IOP elevation, 1 ghost cell glaucoma, 2 NVG requiring medical treatment, 3 new onset partial thickness MH with good VA, 1 postop RD subsequently repaired & 1 spontaneously resolving peripheral choroidal hemorrhage. Posterior capsule tear occurred in 6 eyes.

Conclusions:: In eyes of DM patients with visually significant cataract and severe vitreoretinal pathology, combined CE/PPV generally results in improved VA and most eyes achieve anatomic success although some (especially MH) did not. Postop complications occurred in 13%. Direct comparison to a contemporaneous patient cohort of PPV without CE by the same surgeon will be presented to identify risks specific to the combined surgery.

Keywords: diabetic retinopathy • vitreoretinal surgery • cataract