Abstract
Purpose :
Studies have noted the benefits of phacovitrectomy over pars plana vitrectomy (PPV) with subsequent cataract surgery for proliferative diabetic retinopathy (PDR) may include improved intraoperative view through a clear lens, avoidance of additional anesthesia, lower financial cost to patients, and a quicker visual recovery time frame. However, past studies have also raised concerns that there may be increased risk of iris neovascularization (NVI) and neovascular glaucoma with a variable rate of 0-15%. This is a retrospective study of the clinical and anatomic outcomes of concurrent phacovitrectomy surgery in eyes with PDR.
Methods :
Retrospective study of all patients who underwent phacovitrectomy with the same cornea and vitreoretinal surgeons (2010-17). Eyes with prior surgery, trauma, or retinal co-morbidities were excluded. Pre-operative data collected included age, gender, visual acuity, surgical indication(s), intra-operative complications. Post-operative data was collected at post-operative months 1, 3, 6, 9, 12, and last visit (>12 months). Each visit data included visual acuity, anatomic status, and complications.
Results :
26 PDR eyes of 23 patients were included for the indication of tractional retinal detachment (TRD) (14 eyes, group 1) or non-clearing vitreous hemorrhage (VH) without TRD (12 eyes, group 2). Mean follow-up was 28.7 months. In group 1, vision between pre-operative and 1 year post-operative visits was statistically unchanged from -1.03 to -1.46 (p=0.31), but in group 2, vision improved from -1.175 to -0.195 (p=0.005). In group 1 33% improved by at least one line of visual acuity and 77% showed anatomic improvement compared with 100% visual and anatomic improvement in group 2. The most common complications in group 1 were VH (5 eyes, 36%) and recurrent RD (4 eyes, 29%). NVI occurred in 2 eyes (14%) during the follow-up period. Three eyes required repeat PPV for indications other than silicone oil removal. In group 2, CME was noted in 2 eyes (17%) and VH was seen in 1 eye (8%), which required repeat PPV. No NVI was seen.
Conclusions :
Concurrent phacovitrectomy is an effective surgical approach for patients with PDR. Visual outcomes were improved in eyes without pre-operative TRD but unchanged in eyes with TRD. Surgical goals were achieved in all cases, and post-operative complication rates were comparable to historical rates of PPV alone. NVI was noted in only 7.7% of eyes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.