Skip to main content

Advertisement

SpringerLink
Log in

Comparison of postoperative refractive outcome in eyes undergoing combined phacovitrectomy vs cataract surgery following vitrectomy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To investigate the accuracy of preoperative biometry in eyes undergoing combined phacovitrectomy and to compare it with eyes having cataract surgery at a later point in time following vitrectomy.

Methods

Patients with epiretinal membrane or macular hole who underwent combined phacovitrectomy (group 1) or phacoemulsification following pars plana vitrectomy (PPV) (group 2) were included in this retrospective, comparative, interventional case series. The primary outcome measures were the intraocular lens power prediction error (PE) and the percentage of eyes with PE > ± 0.5D in the two groups. Secondary outcome measures included the correlation between epidemiological, clinical, or surgical factors and dioptric shift. In addition, the influence of optical coherence tomography characteristics to the PE was investigated.

Results

Group 1 and 2 consisted of 55 and 54 eyes, respectively, for a total of 109 eyes included in the study. The mean absolute PE was 0.59 D (range + 1.4 to − 2.5D) in group 1 and 0.35 (range + 1.0 to − 1.45D) in group 2 (p = 0.01). PE greater than 0.5D was observed in 47% of eyes in group 1 as opposed to 16.6% of eyes in group 2 (p = 0.027). The PE was associated with shallower anterior chamber depth (ACD), increased central macular thickness (> 300 μ), and worse baseline best-corrected visual acuity. Photoreceptor ellipsoid zone or external limiting membrane disruption was not associated with significantly greater postoperative refractive deviations.

Conclusion

Combined phacovitrectomy may result in greater postoperative refractive prediction error compared to phacoemulsification alone following vitrectomy. Patients with worse vision, greater central macular thickness, and shallow anterior chambers require more caution since they are prone to inaccurate preoperative biometry.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Koenig SB, Han DP, Mieler WF et al (1990) Combined phacoemulsification and pars plana vitrectomy. Arch Ophthalmol 108:362–364

    CAS  PubMed  Google Scholar 

  2. Koenig SB, Mieler WF, Hann DP, Abrams GW (1992) Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion. Arch Ophthalmol 110:1101–1104

    CAS  PubMed  Google Scholar 

  3. Lahey JM, Francis RR, Fong DS et al (2002) Combining phacoemulsification with vitrectomy for treatment of MHs. Br J Ophthalmol 86:876–878

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Gottlieb CC, Martin JA (2002) Phacovitrectomy with internal limiting membrane peeling for idiopathic macular hole. Can J Ophthalmol 37:277–282

    PubMed  Google Scholar 

  5. Theocharis IP, Alexandridou A, Gili NJ, Tomic Z (2005) Combined phacoemulsification and pars plana vitrectomy for macular hole treatment. Acta Ophthalmol Scand 83:172–175

    PubMed  Google Scholar 

  6. Demetriades A-M, Gottsch JD, Thomsen R, Azab A, Stark WJ, Campochiaro PA, de Juan E Jr, Haller JA (2003) Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol 135:291–296

    PubMed  Google Scholar 

  7. Chaudhry NA, Cohen KA, Flynn HW Jr, Murray TG (2003) Combined pars plana vitrectomy and lens management in complex vitreoretinal disease. Semin Ophthalmol 18:132–141

    PubMed  Google Scholar 

  8. Heiligenhaus A, Holtkamp A, Koch J, Schilling H, Bornfeld N, Losche CC, Steuhl K-P (2003) Combined phacoemulsification and pars plana vitrectomy: clear corneal versus scleral incisions; prospective randomized multicenter study. J Cataract Refract Surg 29:1106–1112

    PubMed  Google Scholar 

  9. Ling R, Simcock P, McCoombes J, Shaw S (2003) Presbyopic phacovitrectomy Br J Ophthalmol 87:1333–1335

    CAS  PubMed  Google Scholar 

  10. Treumer F, Bunse A, Rudolf M, Roider J (2006) Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach. Graefes Arch Clin Exp Ophthalmol 244:808–815

    PubMed  Google Scholar 

  11. Jeoung JW, Chung H, Yu HG (2007) Factors influencing refractive outcomes after combined phacoemulsification and pars plana vitrectomy: results of a prospective study. J Cataract Refract Surg 33:108–114

    PubMed  Google Scholar 

  12. Hurley C, Barry P (1996) Combined endocapsular phacoemulsification, pars plana vitrectomy and intraocular lens implantation. J Cataract Refract Surg 22:462–466

    CAS  PubMed  Google Scholar 

  13. McElvanney AM (1997) Talbot EM (1997) posterior chamber lens implantation combined with pars plana vitrectomy. J Cataract Refract Surg 23:106–110

    CAS  PubMed  Google Scholar 

  14. Scharwey K, Pavlovic S, Jacobi KW (1999) Combined clear corneal phacoemulsification, vitreoretinal surgery and intraocular lens implantation. J Cataract Refract Surg 25:693–698

    CAS  PubMed  Google Scholar 

  15. Suzuki Y, Sakuraba T, Mizutani H, Matsuhashi H, Nakazawa M (2000) Postoperative refractive error after simultaneous vitrectomy and cataract surgery. Ophthalmic Surg Lasers 31:271–275

    CAS  PubMed  Google Scholar 

  16. Smiddy WE, Mady M, Anagnoste S (2001) Acrylic intraocular lens placement in conjunction with pars plana vitrectomy. Am J Ophthalmol 131:748–750

    CAS  PubMed  Google Scholar 

  17. Campo RV, Sipperley JO, Sneed SR, Park DW, Dugel PU, Jacobsen J, Flindall RJ (1999) Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments. Ophthalmology 106:1811–1815

    CAS  PubMed  Google Scholar 

  18. Olsen T (2006) Prediction of the effective postoperative (intraocular lens) anterior chamber depth. J Cataract Refract Surg 32:419–424

    PubMed  Google Scholar 

  19. Kucumen RB, Yenerel NM, Gorgun E, Kulacoglu DN, Dinc UA, Alimgil ML (2008) Anterior segment optical coherence tomography measurement of anterior chamber depth and angle changes after phacoemulsification and intraocular lens implantation. J Cataract Refract Surg 34:1694–1698

    PubMed  Google Scholar 

  20. Falkner-Radler CI, Benesch T, Binder S (2008) Accuracy of preoperative biometry in vitrectomy combined with cataract surgery for patients with epiretinal membranes and macular holes; results of a prospective controlled clinical trial. J Cataract Refract Surg 34:1754–1760

    PubMed  Google Scholar 

  21. Schweitzer KD, Garcia R (2008) Myopic shift after combined phacoemulsification and vitrectomy with gas tamponade. Can J Ophthalmol 43:581–583

    PubMed  Google Scholar 

  22. Tseng PC, Woung LC, Tseng GL, Tsai CY, Chou HK, Chen CC, Liou SW (2012) Refractive change after pars plana vitrectomy. Taiwan J Ophthalmo l2:18–21

    Google Scholar 

  23. Do DV, Gichuhi S, Vedula SS, Hawkins BS (2013) Surgery for post-vitrectomy cataract. Cochrane Database Syst Rev 12:CD006366

    PubMed Central  Google Scholar 

  24. Lee JY, Kim KH, Shin KH, Han DH, Lee DY, Nam DH (2012) Comparison of intraoperative complications of phacoemulsification between sequential and combined procedures of pars plana vitrectomy and cataract surgery. Retina (Philadelphia, Pa) 32(10):2026–2033

    Google Scholar 

  25. Cheng L, Azen SP, El-bradey MH et al (2001) Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study. Am J Ophthalmol 132(6):881–887

    CAS  PubMed  Google Scholar 

  26. Faulborn J, Conway BP, Machemer R (1978) Surgical complications of pars plana vitreous surgery. Ophthalmology 85(2):116–125

    CAS  PubMed  Google Scholar 

  27. Fajgenbaum MAP, Robins J, Williamson TH (2017) Refractive outcomes using the Lenstar optical low coherence Reflectometry biometer in Phacovitrectomy for Epiretinal membranes and macular holes. Open Journal of Ophthalmology 7:216–224

    Google Scholar 

  28. Shams N, Mobaraki H, Kamali M, Jafarzadehpour E (2015) Comparison of quality of life between myopic patients with spectacles and contact lenses, and patients who have undergone refractive surgery. J CurrOphthalmol 27(1-2):32–36

    Google Scholar 

  29. Pan CW, Ramamurtly D, Saw SM (2012) Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt 32:3–16

    PubMed  Google Scholar 

  30. Vu HT, Keeffe JE, McCarty CA, Taylor HR (2005) Impact of unilateral and bilateral vision loss on quality of life. Br J Ophthalmol 89:360–363

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Tranos PG, Ghazi-Nouri SM, Rubin GS, Adams ZC, Charteris DG (2004) Visual function and subjective perception of visual ability after macular hole surgery. Am J Ophthalmol 138(6):995–1002

    PubMed  Google Scholar 

  32. Ghazi-Nouri SMS, Tranos PG, Rubin GS, Adams ZC, Charteris DG (2006) Visual function and quality of life following vitrectomy and epiretinal membrane peel surgery. Br J Ophthalmol 90(5):559–562

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Wagenfeld L, Hermsdorf K, Stemplewitz B, Druchkiv V, Frings A (2017) Refractive predictability in eyes with intraocular gas tamponade – results of a prospective controlled clinical trial. Clin Ophthalmol 11:993–998

    PubMed  PubMed Central  Google Scholar 

  34. Hamoudi H, La Cour M (2013) Refractive changes after vitrectomy and phacovitrectomy for macular hole and epiretinal membrane. J Cataract Refract Surg 39(6):942–947

    PubMed  Google Scholar 

  35. Shioya M, Ogino N, Shinjo U (1997) Change in postoperative refractive error when vitrectomy is added to intraocular lens implantation.J. Cataract Refract Surg 23(8):1217–1220

    CAS  Google Scholar 

  36. Kovács I, Ferencz M, Nemes J, Somfai G, Salacz G, Récsán Z (2007) Intraocular lens power calculation for combined cataract surgery, vitrectomy and peeling of epiretinal membranes for macular oedema. Acta Ophthalmol Scand 85:88–91

    PubMed  Google Scholar 

  37. Patel D, Rahman R, Kumarasamy M (2007) Accuracy of intraocular lens power estimation in eyes having phacovitrectomy for macular holes. J CataractRefractSurg 33:1760–1762

    Google Scholar 

  38. Frings A, Dulz S, Skevas C, Stemplewitz B, Linke SJ, Richard G, Wagenfeld L (2015) Postoperative refractive error after phacovitrectomy for epiretinal membrane with and without macular oedema. Graefes Arch Clin Exp Ophthalmo l253(7):1097–1104

    Google Scholar 

  39. Al M, Legris A (2017) Prognostic factors of epiretinal membranes. A systematic review. J Fr Ophtalmol 40(1):61–79

    Google Scholar 

  40. Chong EW, Mehta JS (2016) High myopia and cataract surgery. Curr Opin Ophthalmo l27(1):45–50

    Google Scholar 

  41. Yang Q-H, Chen B, Peng G-H, Li Z-H, Huang Y-F (2014) Accuracy of axial length measurements from immersion B-scan ultrasonography in highly myopic eyes. Int J Ophthalmol 7(3):441–445

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Sheard R (2014) Optimizing biometry for best outcomes in cataract surgery. Eye (Lond) 28(2):118–125

    CAS  Google Scholar 

  43. Iwase T, Sugiyama K (2006) Investigation of the stability of one-piece acrylic intraocular lenses in cataract surgery and in combined vitrectomy surgery. Br J Ophthalmol 90:1519–1523

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Devgan U (2004) Which IOL formula should be used for which eyes. https://www.healio.com/ophthalmology/cataract-surgery/news/print/ocular-surgery-news/%7Bbf57b195-d532-46da-95f4-c2019665237f%7D/which-iol-formula-should-be-used-for-which-eyes. Accessed 20 Nov 2017

  45. Maeng HS, Ryu EH, Chung TY, Chung ES (2010) Effects of anterior chamber depth and axial length on refractive error after intraocular Lens implantation. J Korean Ophthalmol Soc 51(2):195–202

    Google Scholar 

  46. Hirnschall N, Amir-Asgari S, Maedel S, Findl O (2013) Predicting the postoperative intraocular lens position using continuous intraoperative optical coherence tomography measurements. Invest Ophthalmol Vis Sci 54:5196–5203

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmica Eye Institute, 196 Vassilisis Olgas Street, 54655, Thessaloniki, Greece

    Paris G. Tranos, Miltiadis Balidis, Athanasios Vakalis, Solon Asteriades, Magda Triantafilla & Nikolaos Kozeis

  2. Moorfields Eye Hospital, London, UK

    Bruce Allan

  3. Leicester Royal Infirmary, Leicester, UK

    George Anogeianakis

  4. Association for Biomedical Technology, Thessaloniki, Greece

    Magda Triantafilla

  5. Department of Ophthalmology, University of Patras Medical School, Patras, Greece

    Panagiotis Stavrakas

Authors
  1. Paris G. Tranos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruce Allan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miltiadis Balidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Athanasios Vakalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Solon Asteriades
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George Anogeianakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Magda Triantafilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nikolaos Kozeis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Panagiotis Stavrakas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paris G. Tranos.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the Ophthalmica Eye Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tranos, P.G., Allan, B., Balidis, M. et al. Comparison of postoperative refractive outcome in eyes undergoing combined phacovitrectomy vs cataract surgery following vitrectomy. Graefes Arch Clin Exp Ophthalmol 258, 987–993 (2020). https://doi.org/10.1007/s00417-019-04583-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-019-04583-w

Keywords

Search

Navigation