Visual outcomes and complications of combined vs sequential cataract surgery and pars plana vitrectomy: multicenter database study

Purpose: To compare the visual outcomes and rates of intraoperative complications in eyes that underwent combined cataract extraction (CE) and pars plana vitrectomy (combined group) with those that underwent sequential surgery (sequential group). Setting: Multicenter study. Design: Retrospective chart review. Methods: CE data set pooled from 8 UK sites between 2000 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) and the rate of intraoperative complications in both groups. Results: 2236 eyes in the combined group and 2270 eyes in the sequential group were included in this study. Mean preoperative VA was 1.0 logMAR in both groups. The mean logMAR postoperative VA was worse in the combined group than in the sequential group (P <.0001) at all timepoints, however, the differences in visual improvement between both groups decreased with longer followup time: 1.0 +/- 0.7 vs 0.6 +/- 0.6, 0.7 +/- 0.6 vs 0.4 +/- 0.5, and 0.7 +/- 0.6 vs 0.5 +/- 0.5 at 0 to 4 weeks, 4 to 12 weeks, and 12 to 24 weeks, respectively. Proportions of eyes that gained >3 logMAR units were 49% in the combined group and 66.2% in the sequential group (P <.0001). Logistic regression analysis showed that sequential surgery (odds ratio, 2.1) was a predictor for reaching 20/40 vision by 6 months. In the combined group, there was a statistically significantly higher rate of posterior capsular rupture. Conclusions: Postoperative visual gain was less in the combined group with a higher rate of posterior capsular rupture as compared with sequential phacovitrectomy. However, small differences in visual improvements between both groups by 6 months were observed.