Abstract
Purpose :
This investigation assessed the clinical and anatomic outcomes, safety, and complications associated with combined phacoemulsification and pars plana vitrectomy (PPV) surgeries in eyes with PDR concurrently with significant cataract.
Methods :
A retrospective study was conducted on PDR patients who underwent combined phacovitrectomy surgery by the same cornea and vitreoretinal surgeons (2010-2022). Exclusion criteria: prior surgery, trauma, infectious diseases, or retinal co-morbidities. Demographic data, examination findings, surgical indications, and intra-operative complications were collected. Post-operative best-corrected visual acuity (BCVA, presented as LogMAR, mean±SEM), anatomic improvements, and complication rates were evaluated at defined intervals.
Results :
A total of 44 eyes from 42 patients met the inclusion criteria. Among these, 77.3% presented with vitreous hemorrhage (VH) and 54.6% with tractional retinal detachment (TRD). The mean age was 56.5 (25-72), with 45.2% being female. The average follow-up duration was 27.2 months, and the average HbA1C was 9.3. BCVA demonstrated gradual improvement over time post-surgery, significantly enhancing after 12 months (0.99±0.14, p=0.037) and at the last visit (0.96±0.14, p=0.031), compared to pre-operation (1.36±0.12). Prior to surgery, 61.1% and 88.9% of eyes were treated with pan-retinal photocoagulation (PRP) or anti-VEGF injection, respectively. No intra-operative complications were identified. All eyes were treated intraoperatively with PRP. Internal tamponade was administered in 72.2% of cases (84.6% with gas and 15.4% with silicone oil), and 27.8% received intraoperative Bevacizumab. The most common complication was diabetic macular edema (38.9%). The rate of posterior capsule opacification was 33.3%. The recurrent rates of VH and RD were 27.8% and 13.6%, respectively. Corneal edema peaked at 1 month follow-up (22.2%), and three eyes developed neovascularization of the iris. Five eyes underwent repeat PPV for indications other than silicone oil removal.
Conclusions :
Concurrent phacovitrectomy emerges as an effective surgical approach for patients with PDR, leading to significant visual improvement after 12 months postoperatively. Surgical goals were consistently achieved, and post-operative complication rates were comparable to historical rates associated with PPV alone.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.