Subsequent intraocular lens surgery in eyes with combined versus sequential phaco-vitrectomy

Fatma F Shakarchi; Ahmed F Shakarchi; Mohamed K Soliman; Abdallah A Ellabban; Ahmed B Sallam

doi:10.1016/j.jcjo.2024.11.012

Subsequent intraocular lens surgery in eyes with combined versus sequential phaco-vitrectomy

Can J Ophthalmol. 2024 Dec 23:S0008-4182(24)00366-1. doi: 10.1016/j.jcjo.2024.11.012. Online ahead of print.

Authors

Fatma F Shakarchi¹, Ahmed F Shakarchi², Mohamed K Soliman³, Abdallah A Ellabban⁴, Ahmed B Sallam⁵

Affiliations

¹ Red Cross Red Crescent Movement, Geneva, Switzerland.
² Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AK, United States.
³ University Hospitals Eye Institute, Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH, United States; Department of Ophthalmology, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt.
⁴ Department of Ophthalmology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom.
⁵ Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AK, United States; Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom. Electronic address: [email protected].

PMID: 39726188
DOI: 10.1016/j.jcjo.2024.11.012

Abstract

Objective: To determine the risk factors for subsequent intraocular lens (IOL) surgery among eyes undergoing either combined or sequential phaco-vitrectomy.

Design: Retrospective cohort study.

Participants: Adult patients undergoing phacoemulsification at 8 United Kingdom National Health Service clinical centers between July 2003 and March 2015. Patients undergoing surgery for a dropped nucleus fragment, glaucoma, or iris problems were excluded.

Methods: The eyes were categorized into 3 groups: with previous vitrectomy, undergoing combined phaco-vitrectomy, and with both previous vitrectomy and current combined phaco-vitrectomy. These groups were compared based on preoperative ocular and systemic factors, intraoperative findings, and the subsequent need for a second IOL surgery. The Poisson model was used to calculate adjusted relative risks (aRR).

Results: 5,215 eyes were included: 2,124 with previous vitrectomy, 2,512 with combined phaco-vitrectomy, and 579 eyes with previous vitrectomy and currently combined phaco-vitrectomy. The risk of subsequent IOL surgery was 0.6% (reference group) in eyes with previous vitrectomy, 1.6% (aRR 2.6, CI: 1.4-5.1) in eyes with current combined phaco-vitrectomy, and 3.3% (aRR 3.8, CI: 1.7-8.3) in eyes with previous plus current combined phaco-vitrectomy. Other significant risk factors were age (aRR 0.98/year), pseudoexfoliation (aRR 6.76, CI: 2-28), zonular dialysis (aRR 10.6, CI: 4.8-24), scleral buckle in the current surgery (aRR 8.05, CI: 4-14), and the use of silicone oil (aRR 3.6, CI: 1.6-8.4) compared to no tamponade.

Conclusions: Combined phaco-vitrectomy was associated with a higher risk of IOL complications than sequential surgery. This information is useful for planning surgery in patients requiring both cataract and retinal surgeries.