Subsequent intraocular lens surgery in eyes with combined versus sequential phacovitrectomy

To determine the risk factors for subsequent intraocular lens (IOL) surgery among eyes undergoing either combined or sequential phacovitrectomy.

Retrospective cohort study.

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.

The eyes were categorized into 3 groups: with previous vitrectomy, undergoing combined phacovitrectomy, and with both previous vitrectomy and current combined phacovitrectomy. 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).

5,215 eyes were included: 2,124 with previous vitrectomy, 2,512 with combined phacovitrectomy, and 579 eyes with previous vitrectomy and currently combined phacovitrectomy. 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 phacovitrectomy, and 3.3% (aRR 3.8, CI: 1.7-8.3) in eyes with previous plus current combined phacovitrectomy. 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.

Combined phacovitrectomy 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.