Home > Archive>Volume 17, Issue 3, 2024 >528-536. DOI:10.18240/ijo.2024.03.15
PDF HTML XML Export Cite reminder
Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract: a randomized clinical trial
Author:
Corresponding Author:

Ming-Xing Wu. State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510275, Guangdong Province, China. wumingx@mail.sysu.edu.cn

  • Article
    • | |
  • Metrics
    • |
  • Reference [36]
    • |
  • Related [20]
    • | | |
  • Comments
    Abstract:

    AIM: To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) compared to those of PPV with subsequent cataract surgery. METHODS: This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR, aged >45y, with mild cataracts. The participants were randomly assigned to the combined (PPV combined with simultaneously cataract surgery, i.e., phacovitrectomy) or subsequent (PPV with subsequent cataract surgery 6mo later) group and followed up for 12mo. The primary outcome was the change in best-corrected visual acuity (BCVA) from baseline to 6mo, and the secondary outcomes included complication rates and medical expenses. RESULTS: In total, 129 patients with PDR were recruited and equally randomized (66 and 63 in the combined and subsequent groups respectively). The change in BCVA in the combined group [mean, 36.90 letters; 95% confidence interval (CI), 30.35–43.45] was significantly better (adjusted difference, 16.43; 95%CI, 8.77–24.08; P<0.001) than in the subsequent group (mean, 22.40 letters; 95%CI, 15.55–29.24) 6mo after the PPV, with no significant difference between the two groups at 12mo. The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma (17.65% vs 3.77%, P=0.005). No significant differences were found in the photocoagulation spots, surgical time, and economic expenses between two groups. In the subsequent group, the duration of work incapacity (22.54±9.11d) was significantly longer (P<0.001) than that of the combined group (12.44±6.48d). CONCLUSION: PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness, safety and convenience, compared to sequential surgeries.

    Reference
    1 Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet 2010;376(9735):124-136.
    2 Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Chen SSJ, Rivas A, Toor PP, Banfield L, Thabane L, Chaudhary V, Samaan MC. Global prevalence of diabetic retinopathy in pediatric type 2 diabetes: a systematic review and meta-analysis. JAMA Netw Open 2023;6(3):e231887.
    3 Ghamdi AHA. Clinical predictors of diabetic retinopathy progression; A systematic review. Curr Diabetes Rev 2020;16(3):242-247.
    4 Ang MJ, Afshari NA. Cataract and systemic disease: a review. Clin Exp Ophthalmol 2021;49(2):118-127.
    5 Faramawi MF, Delhey LM, Chancellor JR, Sallam AB. The influence of diabetes status on the rate of cataract surgery following pars Plana vitrectomy. Ophthalmol Retina 2020;4(5):486-493.
    6 Markatia Z, Hudson J, Leung EH, Sajjad A, Gibbons A. The postvitrectomy cataract. Int Ophthalmol Clin 2022;62(3):79-91.
    7 Hernandez-Bogantes E, Abdala-Figuerola A, Olivo-Payne A, Quiros F, Wu L. Cataract following pars plana vitrectomy: a review. Semin Ophthalmol 2021;36(8):824-831.
    8 Lin KY, Hsih WH, Lin YB, Wen CY, Chang TJ. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig 2021;12(8):1322-1325.
    9 Jun SY, Hwang DD. Effect of vitrectomy with silicone oil tamponade and internal limiting membrane peeling on eyes with proliferative diabetic retinopathy. Sci Rep 2022;12(1):8076.
    10 Belin PJ, Parke DW 3rd. Complications of vitreoretinal surgery. Curr Opin Ophthalmol 2020;31(3):167-173.
    11 Almony A, Holekamp NM, Bai F, Shui YB, Beebe D. Small-gauge vitrectomy does not protect against nuclear sclerotic cataract. Retina 2012;32(3):499-505.
    12 Bellucci C, Benatti L, Rossi M, Tedesco SA, Carta A, Calzetti G, Gandolfi S, Mora P. Cataract progression following lens-sparing pars plana vitrectomy for rhegmatogenous retinal detachment. Sci Rep 2022;12(1):22064.
    13 Daud F, Daud K, Popovic MM, Yeung S, You YY, Cruz Pimentel M, Yan P. Combined versus sequential pars plana vitrectomy and phacoemulsification for macular hole and epiretinal membrane: a systematic review and meta-analysis. Ophthalmol Retina 2023;7(8): 721-731.
    14 Kasyanov AA, Vinogradova EY. Distinctive features of phacoemulsification in previously vitrectomized eyes. Vestn Oftalmol 2020;136(5. Vyp. 2):301-307.
    15 Ostri C, Lux A, Lund-Andersen H, la Cour M. Long-term results, prognostic factors and cataract surgery after diabetic vitrectomy: a 10-year follow-up study. Acta Ophthalmol 2014;92(6):571-576.
    16 Shousha MA, Yoo SH. Cataract surgery after pars plana vitrectomy. Curr Opin Ophthalmol 2010;21(1):45-49.
    17 Do DV, Gichuhi S, Vedula SS, Hawkins BS. Surgery for post-vitrectomy cataract. Cochrane Database Syst Rev 2013;12(12): CD006366.
    18 Yang H, Yu X, Sun X. Neovascular glaucoma: handling in the future. Taiwan J Ophthalmol 2018;8(2):60-66.
    19 Kwon JW, Jee D, La TY. Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy. Medicine (Baltimore) 2017;96(10):e6263.
    20 Sánchez-Tabernero S, Juberías JR, Artells N, Crespo-Millas S, Meneses C, Muñoz-Moreno MF, Manzanas L, López Gálvez MI. Management and systemic implications of diabetic neovascular glaucoma. Ophthalmic Res 2019;62(2):111-115.
    21 Diolaiuti S, Senn P, Schmid MK, Job O, Maloca P, Schipper I. Combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in severe proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging 2006;37(6):468-474.
    22 Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, Lansingh VC, Maia M, Mathenge W, Moreker S, Muqit MMK, Resnikoff S, Verdaguer J, Zhao PQ, Ferris F, Aiello LP, Taylor HR. Guidelines on diabetic eye care: the international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology 2018;125(10):1608-1622.
    23 Awidi AA, Mathews PM, Shekhawat N, Woreta FA, Srikumaran D, Daoud YJ. Comparison of simultaneous vs sequential pars Plana vitrectomy and cataract surgery. BMC Ophthalmol 2023;23(1):74.
    24 Silva PS, Diala PA, Hamam RN, Arrigg PG, Shah ST, Murtha TL, Schlossman DK, Cavallerano JD, Sun JK, Aiello LP. Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes. Retina 2014;34(10):1960-1968.
    25 Gershoni A, Barayev E, Jbara D, Hadayer A, Axer-Siegel R, Dotan A, Gal-Or O, Tuuminen R, Ehrlich R. Postoperative complications of combined phacoemulsification and pars plana vitrectomy in diabetic retinopathy patients. Front Med 2022;9:978346.
    26 Lee P, Wang CC, Adamis AP. Ocular neovascularization: an epidemiologic review. Surv Ophthalmol 1998;43(3):245-269.
    27 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(11):2001-2005.
    28 Xiao K, Dong YC, Xiao XG, Liang SZ, Wang J, Qian C, Wan GM. Effect of pars plana vitrectomy with or without cataract surgery in patients with diabetes: a systematic review and meta-analysis. Diabetes Ther 2019;10(5):1859-1868.
    29 Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT, Group GDRP. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003;110(9):1677-1682.
    30 Davison JA, Chylack LT. Clinical application of the lens opacities classification system III in the performance of phacoemulsification. J Cataract Refract Surg 2003;29(1):138-145.
    31 Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD; National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item national eye institute visual function questionnaire. Arch Ophthalmol 2001;119(7):1050-1058.
    32 Limon U, Sezgin Akçay BI. Efficacy of intravitreal dexamethasone after combined phacoemulsification and pars plana vitrectomy for diabetic tractional retinal detachments. J Ocul Pharmacol Ther 2022;38(2):176-182.
    33 Dong N, Xu B, Wang B, Chu L, Tang X. Aqueous cytokines as predictors of macular edema in patients with diabetes following uncomplicated phacoemulsification cataract surgery. Biomed Res Int 2015;2015:126984.
    34 Chono I, Miyazaki D, Miyake H, Komatsu N, Ehara F, Nagase D, Kawamoto Y, Shimizu Y, Ideta R, Inoue Y. High interleukin-8 level in aqueous humor is associated with poor prognosis in eyes with open angle glaucoma and neovascular glaucoma. Sci Rep 2018;8(1):14533.
    35 Gu R, Zhou M, Jiang C, Yu J, Xu G. Elevated concentration of cytokines in aqueous in post-vitrectomy eyes. Clin Exp Ophthalmol 2016;44(2):128-134.
    36 Port AD, Nolan JG, Siegel NH, Chen XJ, Ness SD, Subramanian ML. Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification. Graefes Arch Clin Exp Ophthalmol 2021;259(1):45-52.
    Cited by
    Comments
    Comments
    分享到微博
    Submit
Get Citation

Wei-Bo Feng, Lei Zheng, Ying-Qi Li,/et al.Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract: a randomized clinical trial. Int J Ophthalmol, 2024,17(3):528-536

Copy
Share
Article Metrics
  • Abstract:173
  • PDF: 746
  • HTML: 0
  • Cited by: 0
Publication History
  • Received:October 07,2023
  • Revised:January 12,2024
  • Online: February 27,2024
You are the 4446919 Visitors
Governing Body：Department of Health, Provincial Government of Shaanxi, China
Organizer：Xi'an Medical Association of China
Address：Room 11707-08, Building 2, Unit 1, Wanda Plaza, No.8 Yanta North Road, Xi'an 710054, Shaanxi Province, China
Fax：(8629)82245172 Phone：(+8629)82245172/82210956
Email：ijopress@163.com
International Journal of Ophthalmology ® 2025 All Rights Reserved   The terms of CC BY-NC-ND 4.0 are applicable to all open access content.