Combined Pars Plana Vitrectomy (PPV) and Phacoemulsification (Phaco) versus PPV and Deferred Phaco for Patients with Macular Hole (MH) or Epiretinal Membrane (ERM)

Abstract

Purpose : To compare 48-week functional and anatomical outcomes associated with combined PPV and phaco versus PPV and deferred phaco in patients with MH or ERM

Methods : Prospective study including 84 patients with MH or ERM with no cataract or with lens opacity lower than grade II cortical/nuclear according to the Lens Opacity Classification System(LOCS) III. Patients were randomly assigned to one of two groups. Group I:combined PPV and phaco; Group II:PPV and deferred phaco. Ophthalmologic evaluation (baseline, 4, 12, 24, 36 and 48 weeks) included ETDRS BCVA, LOCS III lens opacity classification, specular microscopy(Konan Medical Inc., California, USA), SD-OCT(Heidelberg, Germany) and microperimetry (MAIA, Italy). In group II, phaco could be performed at any time after PPV if the cataract severity was LOCS subcapsular≥1 or nuclear ≥3 or cortical ≥3, or if the patient had, in the opinion of the investigator, (1)any cataract that would prevent valid microperimetry or OCT evaluation or (2)any decrease in BCVA attributable to cataract

Results : To date, 49 patients (49 eyes;4 ERM/group) completed the 48-week visit. MH stages 3 and 4 represented 60% of cases in both groups. All group II patients(n=24) who completed the 48-week study period underwent phaco. Mean(± SD) age was 68.3±6.5 and 66.9±5.2 years in groups I and II, respectively(p=0.94). Mean BCVA(logMAR) was 0.93±0.05 and 0.91±0.06 at baseline and improved significantly to 0.59±0.06 and 0.57±0.09 at week 48(p<0.0001) in groups I and II, respectively, with no significant difference between groups (p=0.47). Mean MH size(μm) was 470.20±214.48 and 431.57±146.55 at baseline(p=0.51) and MH closure rate was 72% and 78% (p=0.35) in groups I and II, respectively. Mean macular sensitivity threshold(dB) was 18.52±1.04 and 17.68±1.31 at baseline and improved significantly to 21.42±0.89 and 21.20±1.37 at week 48(p<0.05) in groups I and II, respectively, with no difference between groups(p=0.70). Mean endothelial cell density(cells/mm²) was 2423.31±75.30 and 2537.00±70.35 at baseline and decreased significantly to 2130.41±92.61 and 2034.35±119.53 at week 48(p<0.05) in groups I and II, respectively, with no difference between groups(p=0.16)

Conclusions : Combined PPV and phaco was associated with similar anatomical and functional results when compared to PPV and deferred phaco in patients with MH or ERM

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.