Efficacy and safety of primary posterior capsulotomy in combined phaco-vitrectomy in rhegmatogenous retinal detachment

Abstract

Objective: To evaluate the efficacy and safety of posterior capsulotomy by analyzing the long-term visual outcomes in patients with rhegmatogenous retinal detachment (RD), who underwent combined phaco-vitrectomy with or without primary posterior capsulotomy.

Methods: A retrospective longitudinal cohort analysis was performed by using data of rhegmatogenous RD patients undergoing combined phaco-vitrectomy. Patients were divided into two groups; Group A (68 eyes of 68 patients) with capsulotomy, and Group B (39 eyes of 39 patients) without capsulotomy. We reviewed the best-corrected visual acuity (BCVA), incidence of posterior capsule opacification (PCO), clinical features at the diagnosis of rhegmatogenous RD, and intraoperative or postoperative complications following posterior capsulotomy.

Results: The modified BCVA measured by the logarithm of the minimum angle of resolution at initial diagnosis and 3, 6, and 12 months after surgery was 0.67 in Group A versus 0.85 in Group B (p = 0.258), 0.40 in Group A versus 0.50 in Group B (p = 0.309), 0.27 in Group A versus 0.45 in Group B (p = 0.055), and 0.21 in Group A versus 0.47 in Group B (p = 0.014), respectively. In subgroup with macula-on RRD, Group A exhibited better visual outcomes compared to Group B at 6(0.17 versus 0.40 [p = 0.037]) and at 12 months(0.14 versus 0.39 [p = 0.030]). The incidence of PCO in Group B was higher than Group A(28.2% versus 4.4% (p < 0.001)). There were no complications associated with posterior capsulotomy.

Conclusions: A primary posterior capsulotomy during combined phaco-vitrectomy using a 23-gauge vitreous cutter was a safe and effective surgical procedure in patients with RRD patients for preventing postoperative intraocular lens-related PCO.

Fig 1. Kaplan-Meier plots showing the posterior capsule opacification (PCO)-free survival probability of the two groups.

The PCO percentage was analyzed at 12 months after combined phaco-vitrectomy, involving 4.4% of the patients (3/68 eyes) in Group A treated with primary posterior capsulotomy and 28.2% of the patients (11/39 eyes) in Group B who were not treated with capsulotomy. The percentage difference was statistically significant between the two groups (p < 0.001; log-rank test).

Fig 2. An anterior segment photograph of a 48-year-old male with rhegmatogenous retinal detachment after posterior capsulotomy using 23-gauge combined phaco-vitrectomy.

PCO was not detected, with a central optical clear zone over 12 months postoperatively.

Fig 3. The change in best-corrected visual acuity(BCVA) in all 107 patients after combined phaco-vitrectomy for rhegmatogenous retinal detachment.

Unmodified BCVA was no statistically significant difference between the two groups for all periods. The error bars represent the mean ± standard deviation.

Fig 4. The change in modified best-corrected visual acuity(BCVA) in all 107 patients after combined phaco-vitrectomy for rhegmatogenous retinal detachment.

In the group treated with capsulotomy, the mean modified BCVA was significantly better than that in the group not treated with capsulotomy at 12 months (*p = 0.014, independent t-test). The error bars represent the mean ± standard deviation.

Fig 5. The modified best-corrected visual acuity(BCVA) change in 53 macular-on patients at the first visit after combined phaco-vitrectomy for rhegmatogenous retinal detachment.

In the group treated with capsulotomy, the mean modified BCVA was significantly better than that in the group not treated with capsulotomy at postoperative 6 months (^†p = 0.037; Mann-Whitney U test) and postoperative 12 months (^†p = 0.030; Mann-Whitney U test). The error bars represent the mean ± standard deviation.