Korean J Ophthalmol.  2015 Jun;29(3):147-154. 10.3341/kjo.2015.29.3.147.

Combined Cataract Extraction and Vitrectomy for Macula-sparing Retinal Detachment: Visual Outcomes and Complications

• Kim KN
• Lee HJ
• Heo DW
• Jo YJ
• Kim JY

• KMID: 2363751
• DOI: http://doi.org/10.3341/kjo.2015.29.3.147

Abstract

PURPOSE
To evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, and vitrectomy for macula-sparing rhegmatogenous retinal detachment.
METHODS
The results of combined vitrectomy with cataract extraction were retrospectively analyzed in patients with preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must also have had macular sparing in a region 6,000 microm in diameter on optical coherence tomography. The anatomical success rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated.
RESULTS
In 56 patients followed postoperatively for more than 12 months, the initial and final surgical success rate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) had worse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases were comprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and two patients with cystoid macular edema. In the remaining 36 patients, there were no significant differences in visual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324).
CONCLUSIONS
In patients with cataracts who develop macula-sparing rhegmatogenous retinal detachment and whose visual prognosis is excellent assuming the retina can be reattached successfully, combined phacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However, the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes, posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods to prevent these postoperative complications.

Keyword

Cataract extraction; Optical coherence tomography; Pars plana vitrectomy; Retinal detachment

MeSH Terms

Adult
Female
Humans
*Lens Implantation, Intraocular/adverse effects
Male
Middle Aged
*Phacoemulsification/adverse effects
Postoperative Complications/prevention & control
Retinal Detachment/physiopathology/*surgery
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome
Visual Acuity
*Vitrectomy/adverse effects

Reference

1. Schepens CL, Okamura ID, Brockhurst RJ. The scleral buckling procedures. I. Surgical techniques and management. AMA Arch Ophthalmol. 1957; 58:797–811.

2. Hilton GF, Grizzard WS. Pneumatic retinopexy: a two-step outpatient operation without conjunctival incision. Ophthalmology. 1986; 93:626–641.

3. Norton EW. Intraocular gas in the management of selected retinal detachments. Trans Am Acad Ophthalmol Otolaryngol. 1973; 77:OP85–OP98.

4. Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75:813–820.

5. Barrie T. Debate overview: repair of a primary rhegmatogenous retinal detachment. Br J Ophthalmol. 2003; 87:790.

6. Salicone A, Smiddy WE, Venkatraman A, Feuer W. Visual recovery after scleral buckling procedure for retinal detachment. Ophthalmology. 2006; 113:1734–1742.

7. Mendrinos E, Dang-Burgener NP, Stangos AN, et al. Primary vitrectomy without scleral buckling for pseudophakic rhegmatogenous retinal detachment. Am J Ophthalmol. 2008; 145:1063–1070.

8. Tornambe PE, Hilton GF. Pneumatic retinopexy: a multicenter randomized controlled clinical trial comparing pneumatic retinopexy with scleral buckling. The Retinal Detachment Study Group. Ophthalmology. 1989; 96:772–783.

9. Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology. 2007; 114:2142–2154.

10. Heimann H, Zou X, Jandeck C, et al. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol. 2006; 244:69–78.

11. Tani P, Robertson DM, Langworthy A. Prognosis for central vision and anatomic reattachment in rhegmatogenous retinal detachment with macula detached. Am J Ophthalmol. 1981; 92:611–620.

12. Burton TC. Preoperative factors influencing anatomic success rates following retinal detachment surgery. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977; 83:OP499–OP505.

13. Kaufman PL. Prognosis of primary rhegmatogenous retinal detachments. 2. Accounting for and predicting final visual acuity in surgically reattached cases. Acta Ophthalmol. 1976; 54:61–74.

14. Hassan TS, Sarrafizadeh R, Ruby AJ, et al. The effect of duration of macular detachment on results after the scleral buckle repair of primary, macula-off retinal detachments. Ophthalmology. 2002; 109:146–152.

15. D'Amico DJ. Clinical practice: primary retinal detachment. N Engl J Med. 2008; 359:2346–2354.

16. D'Amico DJ. Vitreoretinal surgery: principles and applications. In : Albert DM, Jakobiec FA, editors. Principles and practice of ophthalmology. 2nd ed. Philadelphia: WB Saunders;2000. p. 2402–2421.

17. De Bustros S, Thompson JT, Michels RG, et al. Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes. Am J Ophthalmol. 1988; 105:160–164.

18. Hsuan JD, Brown NA, Bron AJ, et al. Posterior subcapsular and nuclear cataract after vitrectomy. J Cataract Refract Surg. 2001; 27:437–444.

19. Melberg NS, Thomas MA. Nuclear sclerotic cataract after vitrectomy in patients younger than 50 years of age. Ophthalmology. 1995; 102:1466–1471.

20. Treumer F, Bunse A, Rudolf M, Roider J. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation: comparison of clinical complications in a combined versus two-step surgical approach. Graefes Arch Clin Exp Ophthalmol. 2006; 244:808–815.

21. Lahey JM, Francis RR, Fong DS, et al. Combining phacoemulsification with vitrectomy for treatment of macular holes. Br J Ophthalmol. 2002; 86:876–878.

22. Lahey JM, Francis RR, Kearney JJ. Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases. Ophthalmology. 2003; 110:1335–1339.

23. McDonald HR, Johnson RN, Ai E, et al. Macualr epiretinal membranes. In : Ryan SJ, editor. Retina. Vol. 3. 3rd ed. St. Louis: Mosby;2001. p. 2531–2546.

24. Wensheng L, Wu R, Wang X, et al. Clinical complications of combined phacoemulsification and vitrectomy for eyes with coexisting cataract and vitreoretinal diseases. Eur J Ophthalmol. 2009; 19:37–45.

25. Heo MS, Kim HW, Lee JE, et al. The clinical features of macular pucker formation after pars plana vitrectomy for primary rhegmatogenous retinal detachment repair. Korean J Ophthalmol. 2012; 26:355–361.

26. Kiss CG, Richter-Muksch S, Sacu S, et al. Anatomy and function of the macula after surgery for retinal detachment complicated by proliferative vitreoretinopathy. Am J Ophthalmol. 2007; 144:872–877.

27. Apple DJ, Solomon KD, Tetz MR, et al. Posterior capsule opacification. Surv Ophthalmol. 1992; 37:73–116.

28. Toda J, Kato S, Oshika T, Sugita G. Posterior capsule opacification after combined cataract surgery and vitrectomy. J Cataract Refract Surg. 2007; 33:104–107.

29. Sjaarda RN. Macular pucker. In : Ryan SJ, editor. Retina. Vol. 3. 2nd ed. St. Louis: Mosby;1994. p. 2301–2312.

30. Council MD, Shah GK, Lee HC, Sharma S. Visual outcomes and complications of epiretinal membrane removal secondary to rhegmatogenous retinal detachment. Ophthalmology. 2005; 112:1218–1221.

31. Sakimoto S, Saito Y, Nakata K, et al. Surgical outcomes of epiretinal membrane removal after successful pars plana vitrectomy for retinal diseases. Jpn J Ophthalmol. 2008; 52:227–230.

32. Yanyali A, Celik G, Dincyildiz A, et al. Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment. Int J Ophthalmol. 2012; 5:226–230.