Combined Vitrectomy For Epiretinal Membrane Or Floaters And Phacoemulsification With Edof Iol Implantation. Long-Term Anatomical And Functional Results

The present study aims to report the clinical efficacy and safety of combined phacoemulsification, trifocal or extended depth-of-focus (EDOF) intraocular lens (IOL) implantation, and  vitrectomy surgery for treating patients with stage 1 or 2 ERM or floaters, cataracts, and presbyopia

Combined vitrectomy and cataract extraction with implantation of premium customized IOL is uncommon and still considered controversial. The results are believed to be unpredictable. Extremely limited data are available in the literature. However, patients affected by stage 1 or 2 epiretinal membrane (ERM) or clinically significant floaters and cataract might benefit from a combined surgical approach.

A retrospective analysis was performed on two groups of patients. Group 1 was affected by cataract and stage 1 or 2 ERM and Group 2 was affected by cataract and floaters. Both groups underwent cataract surgery with the implantation of a premium extended depth-of-focus intraocular lens (EDOF IOL) and vitrectomy. Corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), corrected near visual acuity (CNVA) and central foveal thickness (CFT) were measured before surgery and at postoperative months1, 3, 6 months and at a last follow up ranging from 1 to 4 years. Furthermore, patients were asked to answer a Quality-of-Life questionnaire and report symptoms of photic phenomena and metamorphopsia at each visit. 

Group 1 (G1) had 20 eyes, Group 2 (G2) 6 eyes. The follow-up ranged 12-48 m. Quality of Life questionnaire reported no visual disturbance, and spectacle independence. Target refraction was met

Mean IOL power was 24 D (range 6.5 to 24) in G1 and 10,5 D (range -5 to 22) in G2.

Mean target refraction was -0,5 D (range 0.12 to -2.5) in G1 and -0,05 D (range 0.48 to -0.15) in G2.

Mean preop BCVA was 0,6 decimal (range 0,9 to 0,2) in G1 and 0,6 decimal (range 0,9 to 0,2) in G2.

Mean preop spheq was -4,43 D (2.75 to -14.00)  in G1 and -11,4 D (-0.75 to -28.00 in G2.

Mean UCVA at 1,3,6 and final follow up was 0,74, 0,89, 0,89, 0,9  in group 1 and 0,83, 0,87, 1, 1 in group 2.

Mean preop CTF was 420 µ (320 to 553 µ)  in G1 and 275 µ (236 to 305 µ) in G2.

Combined vitrectomy for low grade ERM and floaters and cataract extraction with implantation of premium customized IOL might lead to improved distance, intermediate and near uncorrected visual acuity with high accuracy of the refractive prediction and an improved quality of life.