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Shilpa Gulati, Talisa E de Carlo, Ivy Zhu, Elmer Tu, William F Mieler; Clinical and Anatomic Outcomes of Combined Phacovitrectomy Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):876.
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© ARVO (1962-2015); The Authors (2016-present)
Combined phacovitrectomy offers benefits of improved posterior segment visualization through an intraocular lens (IOL), cost savings, and less anesthesia risk relative to consecutive pars plana vitrectomy (PPV) followed by cataract surgery. However, past studies have demonstrated possible increased rates of post-operative complications in combined surgeries. We reviewed the clinical and anatomic outcomes, and complications, of phacovitrectomy in patients without diabetic retinopathy.
This is a retrospective cross-sectional study of all patients who underwent phacovitrectomy with the same corneal and vitreoretinal surgeons (2010-17). Eyes with proliferative diabetic retinopathy, prior surgery or trauma, and other retinal co-morbidities were excluded. Data collected included age, race, gender, BCVA, axial length, surgical indication, IOL diopters, and intra-operative complications. Post-operative BCVA, anatomic improvement, and complications were evaluated at months 1, 3, 6, 9, and 12, and at the most recent visit thereafter.
31 eyes of 31 patients without proliferative diabetic retinopathy underwent phacovitrectomy with mean follow up of 22.4 months. Surgical indications included epiretinal membrane (ERM, 15 eyes), macular hole (MH, 5 eyes), vitreomacular traction (4 eyes), non-clearing vitreous hemorrhage (4 eyes), and rhegmatogenous retinal detachments (3 eyes). Vision improved from -1.089 pre-operatively to a statistically significant degree at post-operative months 1 through 9 but slowly worsened to -0.859 at 1 year, which was a statistically insignificant improvement from baseline (p=0.47). However, 46% improved by at least one acuity line and 92% showed anatomic improvement. The most common complications were CME and RD (each in 1 eye after 12 months). No eyes developed elevated intraocular pressure, fibrinous uveitis, lens dislocation, or posterior synechiae. ERM recurred in 2 of 15 eyes, and 3 of 31 eyes required re-operation (for ERM in 1 eye and persistent MH in 2 eyes).
Phacovitrectomy is a safe and effective approach to achieve anatomic improvement of vitreoretinal diseases in non-diabetic patients. In all cases, intra-operative anatomic goals were achieved, and while there was a statistical improvement in vision up to 9 months postoperatively, the significance was lost at 12 months. Post-operative complication rates were low, historically comparable to rates in PPV alone cases.
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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