Journal List > J Korean Ophthalmol Soc > v.54(3) > 1009619

Ik, Kang, Kang, Seung, Ji, and Boo: Lens-Save Versus Phacoemulsification with Intraocular Lens Implantation in Primary Vitrectomy for Phakic Rhegmatogenous Retinal Detachment

Abstract

Purpose

To compare lens-save and simultaneous phacoemulsification with intraocular lens implantation in primary vitrectomy for phakic rhegmatogenous retinal detachment (RRD).

Methods

A retrospective comparative analysis of 54 consecutive eyes from 54 phakic RRD patients who underwent vitrectomy with a minimum of 12 months of follow-up was performed. The patients were divided into the vitrectomy group and the combined group (patients who underwent vitrectomy with concurrent cataract surgery). The main outcome measures were the best corrected visual acuity (BCVA), anatomical success rate, complications and cataract status according to LOCSⅢ grading.

Results

Baseline characteristics were similar in both groups, except for age and cataract status. The mean age was 46.9 year in the vitrectomy group (n = 20) and 60.5 years in the combined group (n = 34) (p < 0.001). The postoperative BCVA (log MAR) improved from 1.27 and 1.30 at baseline to 0.45 and 0.28 at 12 months (p < 0.05), respectively, which was not a significant difference between the 2 groups. In the vitrectomy group, cataract status was changed from 1.8 at baseline to 2.5 at 12 months (p = 0.001). Two patients (11.1%) had an additional cataract surgery performed. The primary anatomical success rate was 90.0% in the vitrectomy group and 94.1% in the combined group.

Conclusions

The vitrectomy group and combined group had similar results in the repair of phakic RRD. Although postoperative cataract progression was noted, lens should be saved in vitrectomy for young patients, as significant cataract is uncommon.

References

1. Kang SW, Kim SW. The Korean Retina Society, Preferences for treatment modalities of simple rhegmatogenous tetinal detachment in Korea. J Korean Ophthalmol Soc. 2002; 43:1179–85.
2. Heimann H, Bartz-Schmidt KU, Bornfeld N, et al; Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology. 2007; 114:2142–54.
3. Han NS, Lee SB, Kim YB, Jo YJ. Results of triple surgery: cataract extraction, intraocular lens implantation and vitrectomy for retinal detachment. J Korean Ophthalmol Soc. 2004; 45:2041–6.
4. Gu BY, Sagong M, Chang WH. Phacovitrectomy versus vitrectomy only for primary rhegmatogenous retinal detachment repair. J Korean Ophthalmol Soc. 2011; 52:537–43.
crossref
5. Smith M, Raman SV, Pappas G, et al. Phacovitrectomy for primary retinal detachment repair in presbyopes. Retina. 2007; 27:462–7.
crossref
6. Chylack LT Jr., Wolfe JK, Singer DM, et al. The Lens Opacities Classification System Ⅲ. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol. 1993; 111:831–6.
7. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005; 140:509–16.
8. Heimann H, Bornfeld N, Friedrichs W, et al. Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1996; 234:561–8.
crossref
9. Azad RV, Chanana B, Sharma YR, Vohra R. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment. Acta Ophthalmol Scand. 2007; 85:540–5.
crossref
10. Weichel ED, Martidis A, Fineman MS, et al. Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology. 2006; 113:2033–40.
crossref
11. Kang SW, Min JP. Vitrectomy without Dcleral buckling for the treatment of primary rhegmatohenous retinal detachment. J Korean Ophthalmol Soc. 1997; 38:227–35.
12. Heimann H, Zou X, Jandeck C, et al. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol. 2006; 244:69–78.
crossref
13. Von Fricken MA, Kunjukunju N, Weber C, Ko G. 25-Gauge sutureless vitrectomy versus 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachment. Retina. 2009; 29:444–50.
crossref
14. Tsang CW, Cheung BT, Lam RF, et al. Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment. Retina. 2008; 28:1075–81.
crossref
15. Colyer MH, Barazi MK, von Fricken MA. Retrospective comparison of 25-gauge transconjunctival sutureless vitrectomy to 20-gauge vitrectomy for the repair of pseudophakic primary inferior rhegmatogenous retinal detachment. Retina. 2010; 30:1678–84.
crossref
16. Shin MK, Lee JE, Oum BS. Comparison between 20-gauge and 23-gauge vitrectomy system in primary vitrectomy for rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2009; 50:405–11.
crossref
17. Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand. 2005; 83:293–7.
crossref
18. Wickham L, Connor M, Aylward GW. Vitrectomy and gas for inferior break retinal detachment: are the results comparable to vitrectomy, gas, and scleral buckle? Br J Ophthalmol. 2004; 88:1376–9.
19. Demetriades AM, Gottsch JD, Thomsen R, et al. Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol. 2003; 135:291–6.
crossref
20. Oshima Y, Yamanishi S, Sawa M, et al. Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment. Jpn J Ophthalmol. 2000; 44:538–49.
crossref
21. Tewari HK, Kedar S, Kumar A, et al. Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks. Clin Experiment Ophthalmol. 2003; 31:403–7.

Figure 1.
A change of the best corrected visual acuity (BCVA) in the vitrectomy group and the combined group. The post-poerative BCVA of both groups significantly improved from 1.27 ± 1.15 and 1.30 ± 1.04 to 0.45 ± 0.37 and 0.28 ± 0.36 at 12 months, respectively (p = 0.001). The BCVA had no significant difference between two groups.
jkos-54-449f1.tif
Figure 2.
A change of LOCSⅢ score in the Vitrectomy group. LOCS Ⅲ score increased from 1.8 ± 0.79 to 2.2 ± 0.73 (p = 0.002), 2.4 ± 0.93 (p = 0.004) and 2.5 ± 1.12 (p = 0.001) at 3, 6 and 12 months.
jkos-54-449f2.tif
Table 1.
Baseline characteristics
Vitrectomy group (n = 20) Combined group (n = 34) p-value
Gender (M/F) 9/11 12/22 0.480*
Age (mean ± SD) 46.9 ± 11.6 60.5 ± 8.2 <0.001
BCVA (mean ± SD, log MAR) 1.27 ± 1.15 1.30 ± 1.04 0.794
LOCSⅢ score (mean ± SD) 1.8 ± 0.79 3.2 ± 0.87 <0.001
Macular status 0.812
Macular on 7 13
Macular off 13 21
Location of breaks 0.411
Inferior 4 4
Non- inferior 16 30
Type of vitrectomy 0.024
20 gauge 14 13
23 gauge 6 21

Values are presented as mean ± SD.

* Chi square test;

Mann-Whitney U-test;

Fisher exact test.

Table 2.
Postoperative complications
Vitrectomy group (n = 20) Combined group (n = 34) p-value
Elevation of IOP 20.0% (4/20) 47.1% (16/34) 0.079*
Cells in anterior chamber (≥1+) 35.0%(7/20) 94.1% (32/34) <0.001*
Fibrous membrane in anterior chamber 5.0% (1/20) 8.8% (3/34) 1.000*
Retinal re-detachment 10.0% (2/20) 5.9% (2/34) 0.622*
Optic capture NA 5.9% (2/34) 0.525*
Macular pucker 20% (4/20) 29.4% (10/34) 0.553*

* Fisher exact test;

Not applicable.

TOOLS
Similar articles