Postoperative Refractive Error After Simultaneous Vitrectomy and Cataract Surgery

Abstract

* PURPOSE: To evaluate the effect of vitrectomy on postoperative refraction after simultaneous vitrectomy and cataract surgery. * METHODS: We compared the spread between predicted and actual refractions in 206 eyes after a simultaneous vitrectomy, phacoemulsification, aspiration and acrylic lens insertion (combined surgery group), and in 67 eyes after cataract surgery only (cataract surgery group) as control. A vitrectomy was performed for diabetic retinopathy in 127 eyes, macular hole in 32 eyes, rhegmatogenous retinal detachment in 16 eyes, branch retinal vein occlusion in 15 eyes, and other conditions in 26 eyes. In the combined surgery group, 79 eyes had a gas tamponade after insertion of the intraocular lens. * RESULTS: The spread between predicted and actual refractions was -0.05 - 1.18 diopters (average ± SD) in the combined surgery group and +0.55 ± 1.32 D in the cataract surgery group. The actual refractive errors in the combined surgery group were found to shift toward myopia when compared with the controls. Among the combined surgery group, 127 eyes without a gas tamponade showed a postoperative refractive error of +0. 14 ± 1.11 D, while 79 eyes with a gas tamponade demonstrated an error of -0.36 ± 1.22 D. * CONCLUSIONS: Use of a gas tamponade in the combined surgery group increased the myopic change and was thought to have pressed the intraocular lens forward. [Ophthalmic Surg Lasers 2000;31:271-275]

Assessing Refractive Outcomes and Accuracy of Biometry in Phacovitrectomy and Sequential Operations in Patients With Retinal Detachment Compared With Routine Cataract Surgery

“…These include a lower preoperative resulting in both corneal indentation during US biometry and longer postoperative AL, macula-off RRD resulting in signal reflection at the inner limiting membrane instead of the retinal pigment epithelium during OB, and fluctuations in the position of the irislens diaphragm because of gas tamponade and poor fixation. 10,[12][13][14]25 The better refractive outcomes found in our series compared with previous publications may be explained by the use of the SS-OCT (IOL Master 700) OB. Swept-source OCT demonstrated more reliable biometric measurements in eyes with posterior subcapsular cataracts and dense cataracts because of the higher wavelength used (1,055 nm) which has a better penetration and provides an improved visualization of the retina pigment epithelium compared with partial coherence interferometry systems such as the IOL Master 500 (780 nm).…”

Biometric refractive error after cataract and retina surgery: a systematic review and a benchmark proposal

“…Of the 21 articles included in this review, 8 compared refractive error between phacovitrectomy for maculopathies and phacoemulsification alone for cataract, [3,[9][10][11][12][16][17][18] 9 studies investigated phacoemulsification alone [3,10,11,17,[19][20][21], and 6 phacovitrectomy alone. [5,12,13,22,23] In 14 studies on phacovitrectomy, 9 included only macular diseases [3,5,10,12,18,21,[24][25][26] and 5 included a miscellanea of retina disease including retinal detachment [11,13,22,27,28].…”

“…Regarding biometry techniques, 4 studies compared optical with US biometry [11,16,26,29], 6 studies each used optical [5,8,12,13,23,27] or US [3, 17-19, 21, 28] biometry only. Among studies using US biometry, 2 articles reported the refractive error after phacoemulsification in eyes with silicone oil [8,27].…”

“…The latter is calculated as the intended spherical equivalent to predicted spherical equivalent (actual error minus the predicted). The negative refractive error is called myopic shift, while the positive refractive error is called hypermetropic shift [13,14].…”

Intraocular Lens Formula Comparison of Flanged Intrascleral Intraocular Lens Fixation with Double Needle Technique

“…In addition, from the authors' experience, there is an increased risk of developing giant retinal tear associated retinal detachments in certain eyes if the vitreous base is not debulked through a pars plana approach. Previous studies have demonstrated the unpredictable refractive outcomes in patients with previous or concurrent pars plana vitrectomy undergoing cataract phacoemulsification with IOL placement, [24][25][26][27][28][29] which may play a role in the refractive variability in this patient population. Effective lens position for these flanged scleral fixated lenses is highly dependent on the integrity of the natural curvature of the prolene haptics as well as the angle of scleral insertion.…”