Three-year results of combined pars plana vitrectomy and phacoemulsification in diabetic vitreous hemorrhage

Yıl 2022, Cilt: 5 Sayı: 4, 1128 - 1132, 20.07.2022

Mehmet Fatih Karadağ

https://doi.org/10.32322/jhsm.1129291

Öz

Aim: The purpose of this study was to evaluate the efficacy and safety of complications following combined pars plana vitrectomy and phacoemulsification surgery of the eyes for the management of vitreous hemorrhage due to proliferative diabetic retinopathy as well as pronounced cataracts.
Material and Method: Phacoemulsification and 23G pars plana vitrectomy procedures were performed for the management of vitreous hemorrhage and cataracts. Age, gender, best-corrected visual acuity before and after surgery, and intra- and post-operative complications were recorded in patients with cataracts who underwent surgery due to vitreous hemorrhage.
Results: A total of 40 eyes of 40 patients, 22 females (55%) and 18 males, were included in the study. The mean age was 58.7±7.1 (44–76) years. Logmar visual acuity changed from a mean of 2.82±0.5 preoperatively to a mean of 0.7±0.6 postoperatively. Visual acuity increased in 38 eyes (95%) postoperatively. No reduction in visual acuity was observed in any eye. Complications associated with surgery included transient intraocular pressure increase (12 eyes), hyphema (2 eyes), posterior capsule rupture (1 eye), anterior chamber fibrin exudation (4 eyes), neovascular glaucoma (1 eye), vitreous hemorrhage (4 eyes), retinal detachment (1 eye), and posterior capsule opacification (2 eyes).
Conclusion: It was found that combined phacoemulsification and PPV surgery was safe and effective in patients with proliferative diabetic retinopathy. Combined phaco-vitrectomy is a reliable method with a minimum complication profile and prevents the need for subsequent cataract surgery.

Anahtar Kelimeler

Diabetic Retinopathy, Cataract, Phacoemulsification, Vitrectomy

Kaynakça

• Melberg NS, Thomas MA. Nuclear sclerotic cataract after vitrectomy in patients younger than 50 years of age. Ophthalmology 1995; 102: 1466–71.
• R.E. Braunstein, S. Airiani, Cataract surgery results after pars plana vitrectomy, Current Opinion in Ophthalmology 2003; 14: 150–4.
• Gui JM, JiaL, Liu L, Liu JD. Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment. Int J Ophthalmol 2013; 6: 33–41.
• Federman JL, Schubert HD. Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology 1988; 95: 870–6.
• Sneed S, Parrish RK II, Mandelbaum S, O’Grady G. Technical problems of extracapsular cataract extractions after vitrectomy (letter). Arch Ophthalmol 1986; 104: 1126–7.
• Smiddy WE, Stark WJ, Michels RG, Maumenee AE, Terry AC, Glaser BM. Cataract extraction after vitrectomy. Ophthalmology 1987; 94: 483– 487.
• Sizmaz S, Esen E, Isik P, Cam B, Demircan N. Outcome and complications of combined phacoemulsification and 23-Gauge pars plana vitrectomy. J Ophthalmol 2019; 17: 7918237.
• Karaca EE¸ Ozdilek MC, Dursun OA, Yalçın NG, Safety of polyacrylamide 1.5% left in anterior chamber in combined phacoemulsification and pars plana vitrectomy surgery. Curr Eye Res 2016; 41: 501–6.
• Fajgenbaum MAP, Neffendorf JE, Wong RS, Laidlaw DAH, Williamson TH. Intraoperative and postoperative complications in phacovitrectomy for epiretinal membrane and macular hole: a clinical audit of 1000 consecutive eyes. Retina 2018; 38: 1865–1872.
• Jain V, Kar D, Natarajan S, et al. Phacoemulsification and pars plana vitrectomy: a combined procedure, Indian J Ophthalmol 2007; 55: 203–6.
• Zheng QX, Wu RH, Zhang YP, M. Xu, Li WS. Anterior segment complications after phacoemu-lsification combined vitrectomy and foldable intraocular lens implantation, Int J Ophthalmol 2010; 3: 249–54.
• Koushan K, Mikhail M, Beattie A. et al. Corneal endothelial cell loss after pars plana vitrectomy and combined phacoemulsification-vitrectomy surgeries. Canadian J Ophthalmoly 2017; 52: 4–8.
• Silva PS, Diala PA, Hamam RN, et al. Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens in patients with diabetes. Retina 2014; 34: 1960–8.
• Lee DY, Jeong HS, Sohn HJ, Nam DH. Combined 23-Gauge sutureless vitrectomy and clear corneal phacoemulsification in patients with proliferative diabetic retinopathy. Retina 2011; 31: 1753-8.
• Leiderman YI, Andreoli MT, Sun B, Dawood S. Pars plana vitrectomy combined with cataract extraction. Retina 2015; 35: 1059–64.
• 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. Graefe’s Archive for Clin Experiment Ophthalmol 2006; 224: 808–15.
• Pukhraj R. Seenu MH, Ekta R. Long-term outcomes of combined phacoemulsification and pars plana vitrectomy surgery. Ophthalmic Surg Lasers Imaging Retina 2021; 52: 470-7.
• Güven D, Demir M, Ergen E, Y. Sendul, A. Yıldız, S. Cınar. Yirmi üç Gauge pars plana vitrektomi ile birlikte fakoemülsifikasyon ve göz içi lens implantasyonu ameliyatlarının cerrahi sonuçları. Ş.E.E.A.H. Tıp Bülteni 2016; 50: 186-92.
• Lee JY, Kim KH, Shin KH, Han DH, Lee DY, Nam DH. Comparison of intraoperative complications of phacoemulsification between sequential and combined procedures of pars plana vitrectomy and cataract surgery. Retina 2012; 32: 2026–33.
• Koenig SB, Mieler WF, Han DP, Abrams GW. Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion. Arch Ophthalmol 1992; 110: 1101–4.
• Hurley C, Barry P. Combined endocapsular phacoemulsification, pars plana vitrectomy, and intraocular lens implantation. J Cataract Refract Surg 1996; 22: 462–6.
• Özgönül C, Durukan A.H, Erdurman F.C, Gökçe G, Sobacı G, Ceylan O.M. Katarakt ve arka segment patolojilerinin tedavisinde pars plana vitrektomi, fakoemülsifikasyon ve göz içi lensi implantasyonu ile kombine cerrahi yaklaşım. Turk J Ophthalmol 2014; 44: 98-101.
• Sisk RA, Murray TG. Combined phacoemulsification and sutureless 23-gauge pars plana vitrectomy for complex vitreoretinal diseases. Br J Ophthalmol 2010; 94: 1028–32.
• Sood V, Rahman R, Denniston AK. Phacoemulsification and foldable intraocular lens implantation combined with 23-gauge transconjunctival sutureless vitrectomy. J Cataract Refract Surg 2009; 35: 1380–4.
• 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: 1335-9.
• Senn P, Schipper I, Perren B. Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag; a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure. Ophthalmic Surg Lasers 1995; 26: 420–8.
• Chung TY, Chung H, Lee JH. Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes. J Cataract Refract Surg 2002; 28: 2001–5.
• Mochizuki Y, Kubota T, Hata Y, et al. Surgical results of combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation. Eur J Ophthalmol 2006; 16: 279–86.
• Rivas-Aguiño P, Garcia-Amaris RA, Berrocal MH, Sánchez JG, Rivas A, Arévalo JF. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation for the management of cataract and proliferative diabetic retinopathy: comparison versus two-step surgical approach. Arch Soc Esp Oftalmol 2009; 84: 31–8.
• Yang Y, Zhang J, Yan H. Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study. PLoS One 2014; 9: e108933.
• Canan H, Sizmaz S, Altan-Yaycioğlu R. Surgical results of combined pars plana vitrectomy and phacoemulsification for vitreous hemorrhage in PDR. Clin Ophthalmol 2013; 7: 1597-601.
• Ramnani V, Gupta S, Chawla G, Ramnani VK. Evaluation of results of combined Phacoemulsification and Pars Plana Vitrectomy. Panacea J Med Sci 2016; 6: 96-101
• Yang CM. Surgical treatment for diabetic retinopathy: 5-year experience. J Formos Med Assoc 1998; 97: 477–84.
• Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology 1983; 90: 522–30.
• Novak MA, Rice TA, Michels RG, Auer C. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology 1984; 91: 1485–1489.
• West JF, Gregor ZJ. Fibrovascular ingrowth and recurrent hemorrhage following diabetic vitrectomy. Br J Ophthalmol 2000; 84: 822–5.
• Cooper B, Shah GK, Grand MG, Bakal J, Sharma S. Visual outcomes and complications after multiple vitrectomies for diabetic vitreous hemorrhage. Retina 2004; 24: 19–22.
• Demetriades AM, Gottsch JD, Thomsen R, et al. Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol 2003; 135: 291–6.