Cataract Surgery In Eyes With Vitreomacular Traction: Systematic Review And Results From Moorfields Eye Hospital

To systematically review the literature on cataract surgery in patients with vitreomacular traction (VMT) and to present the findings from the largest retrospective case series to date.

Cataract Service, Moorfields Eye Hospital

A systematic review and meta-analysis were conducted up to June 2025 to identify studies on phacoemulsification in VMT patients (protocol number CRD420251068038). Additionally, we retrospectively reviewed records of patients who underwent uncomplicated phacoemulsification with intraocular lens implantation at Moorfields Eye Hospital over the past 1.5 years. Outcomes assessed, were changes in visual acuity (VA), central macular thickness (CMT), and the presence of intraretinal (IRF) or subretinal fluid (SRF), before and after surgery. Rate of VMT release as well as macular hole development and need for secondary vitrectomy were also recorded.

The review identified 2 studies (39 eyes), in which 49% had epiretinal membrane (ERM) and 54% a macular hole preoperatively. Outcomes were mixed, showing no meaningful visual improvement (p=0.89), limited VMT release (15.4%), and a substantial need for secondary vitrectomy (43.6%).

In our series (105 eyes), comorbidities included ERM (7.6%), diabetic macular oedema (6.7%), and retinal vein occlusion (4.8%), with >86% having V-shaped, focal VMT. After 3.8±3.4 months, VA improved (p<0.001), while CMT (p=0.002) and IRF (p=0.025) increased. Cystoid macular oedema developed in 26.7%, macular holes in 2%, VMT release in 5.7%, and secondary vitrectomy was needed in 2%.

Cataract surgery in eyes with VMT improved VA but increased the risk of structural complications, including IRF and CMT, with a low rate of spontaneous VMT release. Careful preoperative assessment and postoperative monitoring are warranted.