Journal d'ophtalmologie clinique et expérimentale
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Long-term Outcomes of Combined Phacovitrectomy with Posterior Capsulectomy for Cataract Treatment in Pathologic Myopia

Yanyun Chen, Shenshen Yan, Dimitrios P Ntentakis, Lin Hua, Xueqian Guo, Xiaoqing Zhu, Bei Tian

Importance: To our knowledge, this is the largest Pathologic Myopia (PM) cohort undergoing combined phacovitrectomy with posterior capsulectomy for cataract treatment.

Background: PM has been documented as an independent risk factor of Retinal Detachment (RD). Coexisting vitreoretinal complications secondary to PM enhance RD incidence, while necessitating additional surgical manipulations to treat cataract than phacoemulsification alone.

Design: Retrospective case series.

Participants: 26 cataract patients (40 eyes) with underlying PM were enrolled from January 2016 to June 2019.

Methods: Participants were treated with a novel combination of phacoemulsification with pars plana vitrectomy (phacovitrectomy) and posterior capsulectomy. Intraocular lens (IOL) was implanted in the capsule bag. Posterior capsulectomy was performed using the 25-gauge vitrectomy cutter though the pars plana.

Main outcome measures: Best-Corrected Visual Acuity (BCVA) logMAR, stability of Spherical Equivalent (SE), intraoperative complications, short- and long-term post-operative complications were evaluated. Normal-distribution variables were described as means (± SD). Continuous variables not following a normal distribution (BCVA logMAR) were expressed as median (± IQR).

Results: A total of 40 eyes of 26 patients (age 53.5 ± 7.80 years, 65.4% female, pre-operative myopia -15.14 ± 5.93 D, axial length 29.69 ± 2.96 mm, intraocular pressure 16.05 ± 3.31 mm of Hg) were analyzed. Follow-up duration was 27.37 ± 7.19 months. 26 eyes (65%) had PM maculopathy. BCVA logMAR at final visit was 0.40 versus 0.75 preoperatively (p<0.001). Laser photocoagulation was required in 21 eyes (52.5%). No gas or silicon oil were used. All IOLs were stably placed in the bag without capsular tearing. No cases of post-operative RD were recorded.

Conclusions: Combined phacovitrectomy with posterior capsulectomy could provide safe and effective treatment for cataract in PM.