Functional Outcomes Of Cataract Surgery With Different Iol Types After Vitrectomy For Macular Hole: An Oct-Guided Approach

To evaluate functional visual outcomes of cataract surgery with implantation of different intraocular lens (IOL) types in eyes after vitrectomy for macular hole, with special emphasis on the role of outer retinal layer integrity assessed by optical coherent tomography (OCT) in individualized IOL selection.

Single centered clinical study conducted at a tertiary ophthalmology center ( Eye microsurgery department)

Eighteen patients  (21 eyes) after vitrectomy for macular hole were included. Phacoemulsification was performed 3-12 months after vitreoretinal surgery due to clinically significant cataract. All patients underwent complete ophthalmic examination, IOL power calculation targeting emmetropia and macula OCT (RTVue XR OCT Avanti, Optovue, Inc. Fremont, CA, USA). Foveal contour, external limiting membrane (ELM), Ellipsoid zone (EZ), interdigitation zone (IZ), and residual post-closure changes were analyzed. IOL types were selected individually based on retinal morphology and functional expectations. Toric IOL were implanted in cases of corneal astigmatism more 0.75D. Visual outcomes were assessed 3 months postoperatively.

Multifocal IOLs were implanted in 4 eyes with restored foveal contour and complete recovery of outer retinal layers, achieving corrected distance visual acuity (CDVA) of 1.0 in 3 eyes and 0.8 in 1 eye, Extended depth of focus IOLs were implanted in 8 eyes with mild irregularities of EZ or IZ or minimal epiretinal membrane (ERM), achieving CDVA of 0.8 in 6 eyes and 0.7 in 2 eyes. Enhanced monofocal IOLs were implanted in 5 eyes with minimal macular changes or early parafoveal atrophy, achieving CDVA of 0.6-0.4, with IDVA of 0.6 at 60 cm in all cases. Monofocal IOLs were implanted in 4 eyes with CDVA from 0.2 to 0.4. Overall, all patients reported high satisfaction with postoperative visual outcomes functionally useful intermediate vision.

Previous vitrectomy for macular hole is not an absolute contraindication to premium IOL implantation. Delaying phacoemulsification after vitrectomy provides a safe assessment  of the integrity of outer retinal layers on OCT  and facilitate selection of the most appropriate IOL. An individualized IOL selection strategy allows achieving favorable visual results, functionally useful intermediate vision, and high patient satisfaction after cataract surgery.