Longterm outcome of combined phaco-vitrectomy with foldable intraocular lens implantation and separated surgey for diabetic retinaopathy

Hong Yan, Ye Yang, Yongxing Xing, Yong Guo

Department of Ophthalmology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China

PURPOSE: Diabetic retinaopathy surgery varies widely regarding the lens transparency, the severity of retinaopathy, and whether or not cataract extraction is undertaken at the same time. To analyse the advantage and disadvantage of combined phacoemulsification cataract surgery and three-port pars plana vitrectomy (CPPV) for diabetic retinaopathy compared with the separated operation and to report the phaco-vitrectomy indications, surgical technique and visual outcome.

METHODS: Study design. Prospective, interventional and non-comparative case series. One-hundred and ten patients with stage V and VI diabetic retinaopathy who underwent combined phaco-vitrectomy during the period April 2009-Oct 2010. Whereas eighty-five patients with diabetic retinaopathy who underwent the separated vitrectomy and later phacoemulsification during the period Nov 2008-Oct 2010. Intervention. All eyes underwent a standard three-port pars plana vitrectomy, cataract extraction with IOL implantation. Main outcome measures were visual acuity (VA), Post-operative anatomic results, visual acuity, preoperative data, and intraoperative and postoperative complications, patient preferences regarding surgical protocol, and subjective improvement in visual function.

RESULTS: Patients were followed up post-operatively for 6 months to 3 years. Visual acuity improved in 83.8% patients. Thirteen patients had raised intraocular pressure following surgery. Thirty patients (30 eyes) had CPPV without primary IOL insertion. The achieved functional results were similar to that achieved in standard phacoemulsification combined with vitreoretinal surgery. The most common postoperative complications in the combined cases included posterior synechiae, elevated intraocular pressure, posterior capsule opacification, macular oedema. Previous vitrectomy does not appear to lessen rates of postcataract surgery macular oedema. Cataract formation is common after vitrectomy in diabetic eyes, and risk of postcataract surgery macular oedema is substantial.

CONCLUSIONS: Combined phaco-vitrectomy with foldable IOL implantation is safe and effective in treating diabetic retinaopathy co-existing with cataract. Cataract formation and risk of postcataract surgery macular oedema should be considered when assessing the long-term benefits of vitrectomy surgery in patients with diabetes. Combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract.