Impact of macular status on intraocular lens power estimation in proliferative diabetic retinopathy eyes undergoing phacovitrectomy

To assess the refractive outcomes and effect of the macular status in eyes with proliferative diabetic retinopathy (PDR) and significant vitreous hemorrhage received with combined phacoemulsification and pars plana vitrectomy (phacovitrectomy).

This retrospective case-control study recruited 176 eyes, including 86 PDR eyes with severe vitreous hemorrhage, who received phacovitrectomy with intraocular lens implantation, and 90 eyes who underwent phacoemulsification only for cataracts (control group). Postoperative follow-up visits documented best-corrected visual acuity (BCVA) and refractive outcomes at each examination. Postoperative refractive outcomes were quantified as spherical equivalents. The primary outcome measure was the refractive prediction error (PE). The PE and absolute prediction error (AE) were employed as key metrics. Additionally, the number and percentage of patients achieving refractions within ±0.25 diopters (D), ±0.50 D, ±0.75 D, ±1.00 D, and ±2.00 D of the target refractive outcome were documented.

The overall mean age was 64.4±10.5y. There were 98 (55.7%) female and 78 (44.3%) male patients. In the PDR eyes with the phacovitrectomy surgery, mean PE (-0.008±0.872 D) and AE (0.662±0.563 D) by ultrasound biometry showed no statistically significant differences as compared to the control group (PE: 0.117±0.621 D, P=0.277; AE: 0.506±0.375 D, P=0.118). Subgroup analysis showed that the PE was significantly different in eyes with macular thickening (-0.471±0.955 D) compared to those without macular thickening (0.161±0.781 D, P=0.002). The PE was negatively correlated with macular thickening in multivariate model analysis [β=-0.568, 95% confidence interval: -0.987 to -0.150, P=0.008].

Combined phacovitrectomy for PDR with severe vitreous hemorrhage exhibits no ultrasound biometry discrepancies as compared to those received phacoemulsification alone. However, the patients with macular thickening show a noticeable myopic shift.