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Awidi AA, Mathews PM, Shekhawat N, Woreta FA, Srikumaran D, Daoud YJ. Comparison of simultaneous vs sequential pars plana vitrectomy and cataract surgery. BMC Ophthalmol 2023; 23:74. [PMID: 36823593 PMCID: PMC9948424 DOI: 10.1186/s12886-023-02801-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
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.
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Affiliation(s)
- Abdelhalim A Awidi
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Priya M Mathews
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Nakul Shekhawat
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Fasika A Woreta
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Divya Srikumaran
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA
| | - Yassine J Daoud
- Cornea, Cataract and Anterior Segment Division, The Wilmer Eye Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 327, Baltimore, MD, 21287, USA.
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Jin KW, Woo SJ, Park KH. Efficacy and safety of primary posterior capsulotomy during phaco-vitrectomy for epiretinal membrane. BMC Ophthalmol 2022; 22:4. [PMID: 34980021 PMCID: PMC8722013 DOI: 10.1186/s12886-021-02226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM). Setting Seoul National University Bundang Hospital, Seongnam, Korea. Design Retrospective consecutive cohort analysis. Methods This study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (−) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively. Results PCO only occurred in capsulotomy (−) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05). Conclusion Primary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.
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Affiliation(s)
- Ki Won Jin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Benson MD, Sia D, Seamone ME, Greve M, Hinz B, Tennant MTS, Baker C, Somani R, Ehmann DS. PHACOVITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT REPAIR: A Retrospective Review. Retina 2021; 41:753-760. [PMID: 32796447 DOI: 10.1097/iae.0000000000002945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the single surgery success rate and anterior segment complications related to phacoemulsification and intraocular lens implantation in a series of patients undergoing phacovitrectomy for all types of primary rhegmatogenous retinal detachment. METHODS We performed a retrospective interventional case series on 302 eyes undergoing phacovitrectomy for primary rhegmatogenous retinal detachment repair between November 1, 2016, and February 2, 2019, in Edmonton, Canada. Primary outcomes included single surgery retinal reattachment rate and anterior segment complications. Secondary outcomes included the effects of proliferative vitreoretinopathy and macula and/or peripheral internal limiting membrane peeling on the rate of surgical success. RESULTS The single surgery success rate of phacovitrectomy for all types of primary rhegmatogenous retinal detachment was 85.1%. The presence of proliferative vitreoretinopathy was associated with lower surgical success (odds ratio, 0.33; P = 0.01). Macular internal limiting membrane peeling was associated with higher surgical success (odds ratio, 2.4; P = 0.05). Anterior segment complications included posterior capsular opacification (28.8%), posterior synechiae (10.9%), and posterior capsular rupture (2.3%). CONCLUSION Phacovitrectomy is a safe and effective treatment option for the primary repair of rhegmatogenous retinal detachments. This study provides evidence to support the safe incorporation of phacoemulsification and intraocular lens implantation with retinal surgery.
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Affiliation(s)
- Matthew D Benson
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada
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Lu B, Xu H, Wang C, Yan Q, Wang X. Influence of the "Inverted U Method" Nd: YAG Laser Posterior Capsulotomy on Anterior Segment Parameters, Decentration and Tilt of Intraocular Lens in Patients after Phaco-vitrectomy. Semin Ophthalmol 2021; 36:88-93. [PMID: 33734918 DOI: 10.1080/08820538.2021.1884267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the effects of the "inverted U method" Nd:YAG laser posterior capsulotomy on anterior segment parameters, decentration and tilt of intraocular lens (IOLs) and visual acuity in posterior capsular opacification (PCO) patients after combined phaco-vitrectomy. METHODS Seventy-six patients (76 eyes) were enrolled in this study, who were diagnosed as PCO and underwent "inverted U method" Nd:YAG laser posterior capsulotomy. All patients had undergone previous combined phaco-vitrectomy for rhegmatogenous retinal detachment. The parameters including IOL decentration, angle of IOL tilt, anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV), central corneal thickness (CCT), keratometry, pupil size, axial length (AL), intraocular pressure (IOP), refractive status, corrected distance visual acuity (CDVA), objective scattering index (OSI) and Chinese version of Visual Function 14 (VF-14) index were obtained before and 3 months after capsulotomy. RESULTS After capsulotomy, the tilt angle and decentration of the IOLs at both vertical (tilt: p = .004, decentration: p = .029) and horizontal meridian (tilt: p = .001, decentration: p = .017) were significantly decreased, ACA increased (p = .015), CDVA (p = .000), VF-14 score (p = .000) and OSI (p = .000) were significantly improved. There were a significant decrease in cylindrical error (p = .001) and a myopic shift in spherical error (p = .001) after the capsulotomy. No significant differences in ACD, ACV, CCT, keratometry, pupil size, AL and IOP were detected (p > .05 for all). CONCLUSION The "inverted U method" Nd: YAG laser posterior capsulotomy decreases tilt and decentration of the IOL, increases ACA and causes no change in ACD, ACV, CCT and IOP in patients after phaco-vitrectomy. These changes make a decrease in cylindrical error and a myopic shift in spherical error. Laser capsulotomy significantly improves visual acuity.
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Affiliation(s)
- Bo Lu
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Haoyan Xu
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Chunxia Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Qichang Yan
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Xinling Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
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Ortoli M, Blanco-Garavito R, Blautain B, Mastorakos N, Souied EH, Glacet-Bernard A. Prognostic factors of idiopathic epiretinal membrane surgery and evolution of alterations of the central cone bouquet. Graefes Arch Clin Exp Ophthalmol 2021; 259:2139-2147. [PMID: 33625565 DOI: 10.1007/s00417-021-05110-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To describe the structural changes observed postoperatively in epiretinal membranes (ERM), in particular the alterations in the central cone bouquet (CB), and to identify prognostic factors that might predict postoperative outcome. METHODS We included 125 eyes of 117 patients who underwent idiopathic ERM removal with at least a 6-month follow-up. For each patient, spectral-domain optical coherence tomography (SD-OCT) was performed and best-corrected visual acuity (BCVA) was measured, before and after surgery. RESULTS Before surgery, 44 eyes (35.2%) presented CB alterations: 65.9% a cotton ball sign, 15.9% a foveolar detachment and 18.2% a pseudovitelliform lesion. Median BCVA increased from 20/63 to 20/32 post-operatively (p = .001) with a mean follow-up of 17 months. The disappearance of CB alterations after surgery was observed in 97.7% of eyes. In stage 3 and 4 ERM, ectopic inner foveal layers persisted in 76.7% of eyes after surgery. Postoperative BCVA was correlated with change in central macular thickness and initial BCVA and was not correlated with the presence of preoperative CB alteration, the initial stage of ERM, the presence of postoperative dissociated optical nerve fiber layer, and the disappearance of ectopic inner fiber layers. The combination of cataract surgery and capsulotomy did not seem to change visual outcome and seemed to accelerate visual recovery. Incidentally, general anesthesia was correlated with final BCVA. CONCLUSION ERM surgery allowed a significant gain in BCVA and the disappearance of CB alterations in the great majority of cases. CB alteration did not show to be associated with poor visual prognosis.
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Affiliation(s)
- Manon Ortoli
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France.
| | - Rocio Blanco-Garavito
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Benjamin Blautain
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Nikitas Mastorakos
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Eric H Souied
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
| | - Agnès Glacet-Bernard
- Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France
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Eid AM, Abd-Elhamid Mehany Elwan S, Sabry AM, Moharram HM, Bakhsh AM. Novel Technique of Pneumatic Posterior Capsulorhexis for Treatment and Prevention of Posterior Capsular Opacification. J Ophthalmol 2019; 2019:3174709. [PMID: 31949950 PMCID: PMC6948290 DOI: 10.1155/2019/3174709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/07/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate a new technique of posterior capsulorhexis using air support to treat primary posterior capsular opacification (PCO) during cataract extraction surgery or to prevent postoperative PCO. SETTING (1) Ophthalmology department, Faculty of Medicine, Minia University, 61519, El-Minia, Egypt. (2) Security Forces Hospital, Ophthalmology Department, Riyadh, Kingdom of Saudi Arabia. DESIGN Prospective, randomized, consecutive case comparative non controlled study. METHODS One hundred eyes of 100 patients with a mean age of 63.3 years with dense cataract were enrolled in the study. Fifty of them (group (1)) were with primary PCO (discovered during the operations) and fifty (group (2)) with clear posterior capsule. All of the patients underwent phacoemulsification and posterior capsulorhexis using the air to support the posterior capsule. Then, IOL implantations were done between the anterior and posterior capsular rims. Postoperatively, each patient was evaluated for the following: visual acuity (UCVA and BCVA), manifest refractive spherical equivalent (MRSE), intraocular pressure, intraocular lens (IOL) stability, visual axis opacification, and posterior segment complications as retinal breaks, retinal detachment, or cystoid macular edema (CME). RESULTS There were no significant differences in UCVA, BCVA, and MRSE. All cases had a clear visual axis, with stable IOL and normal IOP during the follow-up period without posterior segment complications. The VA improved significantly throughout the follow-up periods in both groups without significant clinical difference. CONCLUSION Pneumatic posterior capsulorhexis is a new effective technique for the treatment of primary PCO in dense cataract and for prevention of postoperative PCO with the good visual outcomes and minimal complications. This trial is registered with NCT04007965.
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Affiliation(s)
- Ahmed M. Eid
- Ophthalmology Department, Faculty of Medicine, Minia University, 61519 El-Minia, Egypt
| | - Shaaban Abd-Elhamid Mehany Elwan
- Ophthalmology Department, Faculty of Medicine, Minia University, 61519 El-Minia, Egypt
- Ophthalmology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ahmed M. Sabry
- Ophthalmology Department, Faculty of Medicine, Minia University, 61519 El-Minia, Egypt
| | - Hossam M. Moharram
- Ophthalmology Department, Faculty of Medicine, Minia University, 61519 El-Minia, Egypt
| | - Ashraf M. Bakhsh
- Ophthalmology Department, Security Forces Hospital, Riyadh, Saudi Arabia
- Ophthalmology Department, Faculty of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
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