Comparison of simultaneous vs sequential pars plana vitrectomy and cataract surgery

Abstract

Background To compare the clinical outcomes of patients undergoing sequential pars plana vitrectomy (PPV) followed by cataract extraction surgery (CE) [PPV/CE], simultaneous PPV and CE (PPV + CE), and sequential CE followed by PPV [CE/PPV]. Methods A retrospective observational cohort study of 427 eyes of 404 patients who underwent either sequential or simultaneous PPV and CE surgery between March 2016 and May 2021. Pre-operative and post-operative assessments (up to 2 years of follow-up visits) of uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SEQ), and refractive prediction error (RPE) was done. Main outcome measures were both visual (UCVA, CDVA) and refractive (RPE, SEQ). Results There was a statistically significant difference in CDVA of the PPV/CE, PPV + CE, CE/PPV groups (logMAR 0.34 ± 0.40, 0.65 ± 0.61, and 0.55 ± 0.60, respectively) at one month postoperatively (POM1) (P < 0.001), and at the POM12 visits (logMAR 0.25 ± 0.34, 0.53 ± 0.68, and 0.44 ± 0.48; P = 0.04). In the subgroup analysis of patients with a diagnosis of either epiretinal membrane or vitreous opacities, there was no statistically significant difference in SEQ (P = 0.09) and RPE (P = 0.13) at the combined 1 month and 3 month visits. Conclusion Simultaneous PPV and cataract surgery demonstrated similar improvements in visual acuity and refractive outcomes, as well as comparable intraoperative and postoperative complication profiles to sequential surgery.

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract: a randomized clinical trial

“…Until 6mo, the BCVA improvement in the combined group was significantly superior to that in the subsequent group. In this study, the mean difference in the BCVA improvement 6mo after PPV between the two groups was 14.50 letters, which was almost consistent with previous study results [21][22][23][24] . After the subsequent cataract surgery, no statistic difference was found between the two groups at 12mo, which also verified that the worsen visual prognosis at 6mo in the subsequent group was due to cataract aggravation and the surgical technique were comparable between the two groups.…”

“…Moreover, simultaneous management of anterior and posterior segment pathologies can not only help patients achieve their best visual outcomes earlier but also reduce the number of surgeries and medical burdens. Several previous studies have been conducted, which demonstrated that the combined surgery was effective and gratifying, with optimal prognoses in patients with PDR and dense cataracts [21][22][23][24][25] . However, early lens extraction during PPV in patients with PDR and mild cataracts remains controversial.…”

“…However, early lens extraction during PPV in patients with PDR and mild cataracts remains controversial. Currently, most studies on the combined surgery are retrospective observational studies, focusing on patients with PDR and dense or obvious cataracts obscuring the surgical view [21][22][23][24][25] . Few studies have demonstrated the application and benefits of earlier lens extraction during PPV for PDR patients with mild cataracts, and there is a lack of randomized clinical trials comparing these two surgical approaches as well.…”