Abstract
Background: A cataract inevitably develops after pars plana vitrectomy (PPV) with silicone tamponade. In patients with rhegmatogenous retinal detachment (RRD) of presbyopic age and without significant cataracts, phacoemulsification can be deferred to the time of silicone removal. Alternatively, it can be performed with PPV. Sparse evidence exists to choose one option over the other; this is usually left to the surgeon’s preference. Aim: To compare PPV with silicone tamponade alone, or combined with phacoemulsification for primary RRD, in patients without significant cataracts. Setting: This is a comparative prospective randomised interventional study that was conducted in Cairo University hospitals. Methods: The patients were randomised to two groups, each with 20 phakic patients presenting with RRD. Patients in Group A were randomised to PPV, followed by the phaco-silicone removal. Patients in Group B were randomised to phaco-vitrectomy, followed by silicone removal. Results: No statistically significant difference existed between the groups regarding the rate of intraoperative complications. Group B patients had a higher rate of early postoperative complications (intraocular pressure [IOP], corneal oedema and anterior chamber reaction). At final follow-up there was no statistically significant difference between the groups regarding the rate of retinal attachment or the best corrected visual acuity. Calculation of lens power was significantly more accurate in Group A, as evidenced by the difference in the mean spherical equivalent (Group A: –0.75 dioptre [D] vs Group B: –2.5 D, p = 0.031). Conclusion: This study suggests that no difference exists between the surgical options regarding anatomical success and intraoperative complications. Deferring phacoemulsification until the time of silicone oil removal offers an option with fewer early postoperative complications and more accurate lens power calculation.
Highlights
Following pars plana vitrectomy (PPV) with silicone oil tamponade, a cataract inevitably develops.[1]
Pars plana vitrectomy with silicone oil tamponade was done as the primary procedure in Group A, which was followed three months later by a combined phacoemulsification and silicone oil removal (SOR)
There was no statistical difference in mean preoperative best corrected https://www.avehjournal.org visual acuity (BCVA), lens status, pattern of retinal detachment (RD), macular status or proliferative vitreoretinopathy (PVR)
Summary
Following pars plana vitrectomy (PPV) with silicone oil tamponade, a cataract inevitably develops.[1]. The concept of combining phacoemulsification with PPV emerged to overcome some of the intraoperative difficulties of PPV alone This was especially so after facilitating the ease of removing the vitreous base without the added risk of touching the crystalline lens and ensuring the identification of peripheral retinal breaks. It addressed the difficulties of performing a later cataract extraction on a vitrectomised eye, with the risk of capsular tears.[6]. In patients with rhegmatogenous retinal detachment (RRD) of presbyopic age and without significant cataracts, phacoemulsification can be deferred to the time of silicone removal Sparse evidence exists to choose one option over the other; this is usually left to the surgeon’s preference
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