Vitrectomy Combined With Phacoemulsificafion And Intraocular Lens Implantation For Treatment Of Proliferative Diabetic Retinopathy

ObjectiveTo evaluate the efficacy of vitrectomy combined with phacoemulsificafion and intraocular lens implantation for the treatment of proliferative diabetic retinopathy(PDR).MethodsDesign Retrospective,nonrandomized,noncontrolled case series. Clinical characteristics The medical records of 31 patients who had vitrectomy combined with phacoemulsificafion and intraocular lens implantation for PDR between January 2006 to February 2008 were retrospective analyzed.The series included 31 patients(15 males and 16 females)34 eyes(OD 8;OS 20;OU 3),of which the mean age was 64 years(range 42 to 72 years),with diabetic history for 1-27 years.Preoperatively,visual acuity was light perception,hand motion,finger count,0.02,0.05,0.1,0.2 in 1,10,15,3,3,1,1 eyes.All the patients had clinical significant cataract and vitreous hemorrhage.Ultrasonography indicated localized retinal detachment in 12 eyes.Preoperatively,the severity of PDR consisted of three stages:stageâ…£,â…¤,â…¥in 4,18,12 eyes.Surgical techniques Surgery was performed using a retrobulbar or peribulbar block.Clear corneal phacoemulsification was performed in all cases.Foldable intraocular lens(IOL)implantation preceded or succeeded the vitreoretinal procedure.A standard 3-port pars plana vitrectomy(PPV)was primarily performed using 20-gauge vitreous cutter and an endoilluminator.Laser surgery was performed intraoperatively in all eyes and postoperatively in 3 eyes. The mean follow-up was 7.3 months(range 2 to 25 months).Results1.Visual acuity Postoperatively,visual acuity increased in 28 eyes(82.4%),was unchanged in 4 eyes(11.8%),and was worse in 2 eyes(5.8%).2.The clinical stages of PDR in the patients preoperatively and postoperatively was the same.The IOL power range +8.50 diopters(D)to +24.0D(average +21.0D).Intraoperative complication was hemorrhage at the time of division of the membranes.3.Postoperative complications Postoperative complication consisted of corneal edema(8 eyes),persistent corneal edema or Descemet's fold(1 eye),fibrinoid exudation in the anterior chamber(4 eyes),transient intraocular pressure increase(5 eyes),recurrent vitreous hemorrhage(1 eye),iris neovascularization(1 eye),posterior capsule opacification(3 eyes).ConclusionsVitrectomy combined with phacoemulsificafion and intraocular lens implantation is safe and effective in treating proliferative diabetic retinopathy.Combined surgery may improve the visual outcome in the majority of selected eyes,release the patients' mental and economic pressure by preventing a second operation for postvitrectomy cataract,allowing earlier visual rehabilitation.