Abstract
Purpose :
The decision to perform simultaneous versus sequential cataract extraction (CE) surgery and pars plana vitrectomy (PPV) has several implications for both the patient and the surgeon. We performed a retrospective, clinical study to compare outcomes of simultaneous versus sequential CE and PPV surgery in terms of postoperative visual acuity and refractive outcomes.
Methods :
We assessed three possible combinations of PPV and CE surgery: simultaneous PPV and cataract surgery (PPV+CE); PPV followed by cataract surgery (PPV/CE), and cataract surgery followed by PPV (CE/PPV). A two-year retrospective chart review of 427 eyes with history of PPV and CE was performed. Assessments of UCVA and BCVA, spherical equivalent (SEQ), and target refraction were done. Outcomes studied were UCVA, BCVA, SEQ and refractive prediction error (RPE) at the 1 month, 3 months, 6 months, 1 year, and 2 years postoperative visits. Only patients with epiretinal membrane (ERM) or vitreous opacity (VO) indications in the PPV+CE and PPV/CE were included in the SEQ and RPE calculations.
Results :
In total, 427 eyes of 404 patients were included, of which 113 eyes underwent PPV/CE, 261 eyes underwent PPV+CE, and 53 eyes underwent CE/PPV. Improvement in UCVA and BCVA of the whole patient cohort was seen at every follow-up visit compared to preoperative measures. There was a statistically significant difference in BCVA measures of the PPV/CE, PPV+CE, CE/PPV groups (LogMAR 0.34 ± 0.40, 0.65 ± 0.61, and 0.55 ± 0.60, respectively; P < 0.001) at POM1, and at POM12 (LogMAR 0.25 ± 0.34, 0.53 ± 0.68, and 0.44 ± 0.48, respectively; P = 0.04). At the POM1+3 visits, RPE was within ± 1.0 D in 11 eyes (65%) in the PPV/CE group, and 44 eyes (86%) in the PPV+CE group, while it was within ± 2D in 16 eyes (94%) in the PPV/CE and 51 eyes (100%) in the PPV+CE group.
Conclusions :
Simultaneous PPV and cataract surgery demonstrated a significant improvement in visual and refractive outcomes that were comparable to sequential surgery results. A simultaneous approach may be a suitable option in elective situations as it avoids the gradual deterioration in vision that arises with the progression of cataracts following PPV.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.