Cataracts in vitreoretinal cases

Cataract extraction with regular phacoemulsification surgery can be successfully combined with vitreoretinal surgery in eyes with a wide range of axial lengths (AL) and vitrectomy indications, according to Martin Siemerink MD, PhD. Addressing delegates attending the Clinical Research Symposium on Cataract and Macular Disease at the XXXIV Congress of the ESCRS in Copenhagen,Denmark, Dr Siemerink said that combined surgery offers a lot of potential advantages. “There are some clear benefits to adopting a combined approach in terms of better visualization since the phacoemulsification is performed before vitrectomy. It also offers easy removal of the vitreous, avoiding the need for a second surgery, faster recovery of visual acuity, cost-effectiveness, and the removal of anterior vitreous structures without the risk for touching the lens,” he said. The downsides to such an approach included possible issues with target refraction, myopic shift, accuracy of biometry and intra- and post-operative complications. “At present, standard intraocular lens (IOL) power calculations are implemented without being adapted for the added vitrectomy. Furthermore, the presence of posterior segment pathology can influence accurate preoperative measurements as is associated with lower visual acuity and anatomic changes in the posterior segment,” he said. Refractive accuracy To examine the question further, Dr Siemerink and colleagues evaluated the refractive accuracy of intraocular lens (IOL) power calculation after phaco-vitrectomy in a retrospective comparative case series. Refraction results one month after phaco-vitrectomy or phacoemulsification were compared with predicted refractions calculated using the IOLMaster 500 and the Haigis formula. Indications for vitrectomy were macular pucker, macular hole, vitreous floaters, vitreous haemorrhage, and vitreomacular traction. The phaco-vitrectomy group comprised 133 eyes of 133 patients and the phacoemulsification group, 132 eyes of 132 patients. The refractive outcomes after phaco-vitrectomy and phacoemulsification were comparable, said Dr Siemerink. The final postoperative refraction was within ±1.00 D of the preoperative refractive target in 94.9% and 94.6% of phaco-vitrectomy cases and phacoemulsification cases, respectively. Subgroup analysis found no increased risk for refractive surprises after gas tamponade or in eyes with an AL of 26.00 mm or greater. Summing up, Dr Siemerink said the study showed that standard IOL power calculation used in regular phacoemulsification surgery was accurate in phaco-vitrectomy procedures in eyes with a wide range of AL and a wide range of vitrectomy indications. No risk factors were found for refractive surprise, either in terms of AL or macular thickening. Furthermore, while other studies have reported a tendency towards myopic shift after phaco-vitrectomy procedures, no such trend emerged in this particular study, concluded Dr Siemerink. Martin Siemerink wants to acknowledge doctors Leonie van der Geest, Marco Mura and Ruth Lapid-Gortzak for their contribution to this study. This article is based on a previous published article from Journal of Cataract Refract Surgery, 2016 Jun;42(6):840-5. END Contact: m.j.siemerink@olvg.nl