Impact of Phacoemulsification on Vitreomacular Traction Release and Complications

To determine if phacoemulsification impacts vitreomacular traction (VMT) release and VMT-related complications.

Single-center, comparative, retrospective clinical cohort study.

A TOTAL OF: 310 eyes of 249 patients with a concurrent diagnosis of VMT and cataracts at the Cole Eye Institute between 2013 and 2024.

Eligible eyes had at least 6 months of follow-up post-VMT diagnosis or phacoemulsification. The control group included eyes that did not undergo phacoemulsification after VMT diagnosis. Clinical information was collected via manual chart review. Characteristics of VMT were recorded via review of optical coherence tomography imaging.

The primary outcome was the hazard of VMT release. Secondary outcomes included VMT-related complications, such as macular and lamellar hole formation, retinal detachment, and subsequent vitrectomy.

VMT release occurred in 49.4% of 310 eyes, with an average follow-up period of 136.7 ± 134.4 weeks. There was no significant difference in release between the phacoemulsification and control groups (adjusted hazard ratio [aHR] = 0.861; P = .380). Among eyes that released, the mean time to release was 79.4 ± 68.8 weeks postsurgery in the phacoemulsification group and 76.0 ± 81.9 weeks from diagnosis in the control group (P = .785). In multivariate analysis, younger age at diagnosis (5-year aHR = 0.773; P < .001) and smaller adhesion diameter (per 100 µm aHR = 0.951; P = .017) were significantly associated with a higher likelihood of VMT release. Black patients had a lower likelihood of VMT release compared to White patients (aHR = 0.439; P = .004). Eyes that developed a macular hole had a smaller baseline adhesion diameter than those that did not (439.1 ± 217.9 µm vs 685.7 ± 697.4 µm; P < .001).

Phacoemulsification was not associated with increased rates or faster timing of VMT release. These findings suggest that intrinsic patient and anatomical factors play a larger role in determining the likelihood of VMT release and should be prioritized in clinical decision-making.