Abstract
Objective: To investigate the safety, effectiveness and differences of combined and consecutive surgical strategies on patients with proliferative diabetic retinopathy (PDR) and severe cataract.
Methods: Eighty-four cases (84 eyes) with PDR complications of vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) and severe cataract were enrolled in this retrospective analysis. Thirty-nine eyes in consecutive surgery group underwent the surgery of phacoemulsification (PHACO) and intraocular lens (IOL) implantation firstly, and then received the surgery of vitrectomy, panretinal photocoagulation (PRP) and retinopexy (when necessary) two to twenty-five days later. Forty-five eyes in combined surgery group underwent the combined surgery of PHACO, IOL implantation, vitrectomy, PRP and retinopexy (when necessary). The postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior segment inflammation responses, and surgical complications were chosen as outcome measurements when the two groups were compared.
Results: The demographic data of the patients before surgery had no significant difference between the two groups. There was no statistically significant difference on BCVA at postoperative week 6 between two groups (P>0.05). Postoperative inflammation of the anterior segment in combined surgery group was much more serious than that in consecutive surgery group. 91.1% patients (41 eyes) developed moderate or serious inflammation in combined surgery group at postoperative day 3 compared with 46.2% patients (18 eyes) in consecutive surgery group. In addition, there were still 71.1% patients (32 eyes) with mild or moderate inflammation in combined surgery group at postoperative week 6 compared with 28.2% patients (11 eyes) in consecutive surgery group. The IOP elevated in 20 eyes (44.4%) in combined surgery group and seven eyes (17.9%) in consecutive surgery group. The presence of posterior synechia was found in 10 eyes (22.2%) in combined group and one eye (2.6%) in consecutive group 6 weeks after surgery.
Conclusion: Although both surgery strategies for PDR patients with severe cataract are safe and effective, combined surgery leads to more postoperative complications than consecutive surgery, which should be carefully monitored and properly treated. For PDR patients with severe cataract which perturbs the vitrectomy and PRP, the consecutive surgery is a priority for surgery choice if the patient's condition allows.
Extensive argon laser photocoagulation in the treatment of proliferative diabetic retinopathy.