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Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification

  • Retinal Disorders
  • Published:
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Abstract

Purpose

A majority of phakic patients undergoing pars plana vitrectomy for epiretinal membrane or macular hole require subsequent cataract surgery within 1–2 years. Combined phaco-vitrectomy eliminates the need for a second surgery and may enable patients to attain their best vision sooner. This study aims to compare the visual outcomes, complication rates, and costs of combined phaco-vitrectomy versus sequential vitrectomy followed by cataract surgery.

Methods

Records were searched by CPT® codes to identify patients with both cataract and vitrectomy surgery at our institution over a 5-year period (2013–2018). Chart review included medical history, demographics, exam findings, operating room records, visual acuity (VA), and clinical outcomes. Statistical analyses were performed with SPSS v19 (IBM). Area under the curve for visual acuity was calculated as the trapezoidal mean of the change in Early Treatment of Diabetic Retinopathy Study letters.

Results

After exclusion, 81 eyes of 78 patients underwent both cataract and vitrectomy surgeries at our institution. Thirty-four eyes underwent separate, sequential vitrectomy then phacoemulsification surgery, and 47 eyes had combined phaco-vitrectomy surgery. Total operating room times (120.81 ± 3.41 vs 161.03 ± 5.45 min; p < 0.0001) and associated costs were significantly lower in the combined surgery compared with those in the sequential surgery group. Baseline and final visual acuity were similar between the two groups. Baseline VA was 35.53 letters (~ 20/200) and 32.81 letters (~ 20/220) and increased to final VA of 63.74 (~ 20/53) and 60.91 letters (~ 20/61), in the sequential and combined groups respectively. Area under the curve for vision was greater in the combined surgery group, with subjects gaining an average of + 9.11 ± 3.32 letters from sequential surgery, and + 19.53 ± 3.53 letters in the combined surgery group (p = 0.04). Additionally, patients in the combined group attained their best visual acuity 449 days (15 months) sooner than those receiving sequential surgery.

Conclusions

Combined phaco-vitrectomy surgery resulted in greater area under the curve visual acuity benefit and attainment of best visual acuity 15 months sooner compared with conventional sequential surgeries. There were no significant differences in complication rates or clinical outcomes between the groups, but operative times and costs were lower for combined surgery, supporting a favorable cost-benefit ratio.

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Authors and Affiliations

  1. Department of Ophthalmology, Boston Medical Center, Boston, MA, USA

    Alexander D. Port, John G. Nolan, Nicole H. Siegel, Xuejing Chen, Steven D. Ness & Manju L. Subramanian

  2. Boston University School of Medicine, Boston, MA, USA

    Nicole H. Siegel, Xuejing Chen, Steven D. Ness & Manju L. Subramanian

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  1. Alexander D. Port
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  2. John G. Nolan
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  3. Nicole H. Siegel
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Correspondence to Manju L. Subramanian.

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This is a retrospective study. This article does not contain any studies with human participants or animals performed by any of the authors.

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Institutional Review Board Approval was obtained prior to initiation of chart review.

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Port, A.D., Nolan, J.G., Siegel, N.H. et al. Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification. Graefes Arch Clin Exp Ophthalmol 259, 45–52 (2021). https://doi.org/10.1007/s00417-020-04877-4

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  • DOI: https://doi.org/10.1007/s00417-020-04877-4

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