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Talisa E de Carlo, Shilpa Gulati, Ivy Zhu, Elmer Tu, William F Mieler; Clinical and Anatomic Outcomes of Phacovitrectomy Surgery in Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):856.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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.
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