Phacovitrectomy versus Phacoemulsification after Vitrectomy for Rhegmatogenous Retinal Detachment Repair

A Young Choi; Youngdo Yeo; Yu Cheol Kim

doi:10.7469/JKOS.2015.56.03.357

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Choi, Yeo, and Kim: Phacovitrectomy versus Phacoemulsification after Vitrectomy for Rhegmatogenous Retinal Detachment Repair

Original Article

J Korean Ophthalmol Soc 2015;56(3):357-364.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.357

Phacovitrectomy versus Phacoemulsification after Vitrectomy for Rhegmatogenous Retinal Detachment Repair

A Young Choi, MD, Youngdo Yeo, MD, Yu Cheol Kim, MD, PhD

Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

￭ Address reprint requests to Yu Cheol Kim, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea Tel: 82-53-250-8026, Fax: 82-53-250-7705 E-mail: eyedr@dsmc.or.kr

Received 21 July 20143 December 2014 Accepted 1 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

To compare the outcomes of phacovitrectomy and phacoemulsification after vitrectomy for treatment of rhegmatogenous retinal detachment (RRD).

Methods:

We performed a retrospective comparative analysis of 39 consecutive eyes with phakic primary RRD followed up for more than 6 months. The patients were divided into phacoemulsifcation after vitrectomy and phacovitrectomy groups. The main outcome measures were the best corrected visual acuity (BCVA), anatomical success rate and postoperative complications.

Results:

The mean age was 54.17 years in the phacoemulsifcation after vitrectomy group (n = 23) and 56.69 years in the phacovitrectomy group (n = 16; p = 0.031). The log MAR BCVA improved in both groups with no statistically significant difference between the 2 groups ( p = 0.592). The anatomical success rate after initial surgical intervention was 100% in both groups. Retinal detachment recurred in 3 eyes in the phacoemulsifcation after vitrectomy group; caused by new retinal tear.

Conclusions:

The new RRD rate in phacoemulsification after vitrectomy group was higher than in the phacovitrectomy group. Due to the retrospective and limited data in this study, whether simultaneous combined cataract surgery with retinal detachment surgery should be recommended to reduce RRD risk is inconclusive and further larger, prospectively designed studies are nec-essary to confirm the present findings.

Keywords: Phacoemulsification, Phacovitrectomy, Retinal redetachment

References

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Figure 1.

BCVA change of 2 groups. BCVA = best corrected visual acuity.

Figure 2.

Intraocular tamponade of 2 groups.

Figure 3.

Fundus findings before vitrectomy surgery (A, C, E) and after cataract surgery (B, D, F) of three patients with retinal redetachment after cataract surgery. E: Two horseshoe tears are observed but definite retinal detachment border is not identified due to vitreous hemorrhage. Blue: detached retina; red: new retinal tear; brown: old retinal tear; green: vitreous hemorrhage.

Figure 4.

New retinal tear caused by traction (red arrow) on any remaining anterior hyaloids.

Table 1.

Demographics and clinical data of patients

	Phacoemulsification after vitrectomy (n = 23)	Phacovitrectomy (n = 16)	p-value
Sex (M/F, eyes)	14/9	9/7	1.00
Age (years)	54.17 ± 7.62	56.69 ± 7.63	0.031
Preoperative BCVA (log MAR)	0.91 ± 0.94	0.91 ± 0.97	0.904
Preoperative AL (mm)	24.81 ± 1.82	24.16 ± 0.88	0.344
Follow up (months)	37.83 ± 22.86	21.31 ± 10.23	0.015
Cat-final follow up (months)	23.52 ± 19.55	21.31 ± 10.23	0.471

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; AL = axial length; Cat = cataract surgery.

Table 2.

Severity of retinal detachment of two groups

	Phacoemulsification after vitrectomy (n = 23)	Phacovitrectomy (n = 16)	p-value
Macula on/off detachment (%)
On	7 (30.4)	7 (43.7)	0.394
Off	16 (69.5)	9 (56.2)
Number of retinal tear (number)	1.39 ± 0.67	1.62 ± 0.96	0.708
Involved quadrant (O’clock)	4.65 ± 1.83	4.59 ± 1.80	1.000

Values are presented as mean ± SD unless otherwise indicated.

Table 3.

Postoperative BCVA and complications of two groups

	Phacoemulsification after vitrectomy (n = 23)	Phacovitrectomy (n = 16)	p-value
Postoperative BCVA (log MAR)	0.37 ± 0.33	0.31 ± 0.32	0.592
Postoperative complications (%)	6/23 (26.0%)	0/16 (0.0%)	0.031
Retinal redetachment (%)	3/6 (13.0%)	0/16 (0.0%)	0.255
Secondary ERM (%)	3/6 (13.0%)	0/16 (0.0%)	0.255

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; ERM = epiretinal membrane.

Table 4.

Summary of redetachment cases

	Case 1	Case 2	Case 3
Age (years)	53	51	42
Preoperative BCVA (log MAR)	3.00	0.10	2.00
Preoperative AL (mm)	26.17	26.90	26.75
Intraocular tamponade	SF₆	SF₆	C₃ F₈
Type of IOL	Acrysof IQ	TECNIS TM 1-piece	TECNIS TM 1-piece
Interval of PPV-Cat (months)	8	16	67
Interval of Cat-RD (weeks)	3	6	17
Reoperation	IV C₃ F₈ gas injection	Add PPV+ C₃ F₈ tamponade	Add PPV+ C₃ F₈ tamponade

BCVA = best corrected visual acuity; AL = axial length; IOL = intraocular lens; PPV = pars plana vitrectomy; Cat = cataract surgery; RD = retinal detachment.

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