Outcomes Of Combined Cataract Surgery And Pars Plana Vitrectomy In Patients With Vitreous Opacities Or Mild Macular Pucker

Vitreous opacities contribute to decreased visual quality after cataract surgery, especially with diffractive multifocal intraocular lenses. Epiretinal membrane (ERM) with mild macular pucker is also often visually significant and may worsen after cataract surgery alone. Pars plana vitrectomy with possible inner limiting membrane (ILM) peeling effectively treats these issues, but visual rehabilitation is limited due to cataract progression. This study examines the outcome of combined 25-gauge suture-less pars plana vitrectomy (PPV) performed by a vitreoretinal surgeon, plus phacoemulsification cataract extraction (CE) by a cataract surgeon in the same setting, in a series of patients with good visual potential.

Wills Eye Hospital, Philadelphia PA USA and nearby private clinics

993 patients who underwent combined PPV/CE at Wills Eye Hospital between Jan 2017 – Dec 2021 were identified retrospectively. Those with either vitreous opacities alone or mild macular pucker and without other ocular pathology were selected. Visual acuity (VA), subjective visual symptoms, complete ophthalmic examination and macular OCT were obtained preoperatively and at 1-2 weeks and 3 months postop. Complications, total operative time, secondary interventions, and subjective visual complaints were also recorded. Statistical analysis was performed using t-test and ANOVA to compare to a control group of 30 patients undergoing sequential procedures.

54 cases meeting the inclusion criteria were identified. 83% had ILM peeling and 23% endolaser for occult retinal holes/tears identified during PPV. 10% had a premium IOL (multifocal or toric) implanted. There were no cases of endophthalmitis or retinal detachment. 5 patients had limited vitreous hemorrhage postoperatively, and 2 patients had transient intraocular pressure (IOP) elevation above 21mmHg on 2 consecutive visits. There was no statistically significant increase in macular thickness or IOP through 3 months postop. No secondary surgical interventions were required. Mean postoperative Snellen VA at 1 month was 20/30 uncorrected, a significant increase from preop with p<0.01.

Combined phacoemulsification CE plus 25-gauge PPV for vitreous opacities or mild ERM is safe and effective, providing more rapid visual rehabilitation and convenience for the patient compared to sequential surgery, with no increase in complications. Cataract surgeons may offer their full range of techniques, including advanced technology IOLs and minimally invasive glaucoma surgery (MIGS), with no modification of standard procedure when CE is combined with modern suture-less pars plana vitrectomy.