Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Visual outcomes and complications of combined versus sequential pars plana vitrectomy and phacoemulsification for epiretinal membrane

Eye (2024)Cite this article

Subjects

Abstract

Background

Symptomatic epiretinal membrane (ERM) often requires surgical intervention via pars plana vitrectomy (PPV), for which cataract development is a common complication. There is insufficient data on the visual outcomes and complications of combined phacovitrectomy (COMB) in comparison to sequential PPV with deferred cataract surgery (SEQ) for ERM.

Methods

A retrospective dataset analysis of 8 National Health Service ophthalmology departments. The main outcome measures were postoperative visual acuity (VA), operative complications, postoperative cystoid macular oedema (CMO) and recurrent ERM.

Results

We included 898 and 299 eyes in the COMB and SEQ groups, respectively. Both procedures resulted in significantly better VA across all follow-up intervals (24 weeks). The proportion of eyes with Snellen VA of at least 20/40 at 12-24 weeks was comparable in both groups (47.8% [COMB] vs. 54.7% [SEQ], p = 0.4456). More eyes in the COMB group experienced posterior capsular rupture (2.9% vs. 0%, p = 0.0009) and iatrogenic retinal trauma (2.4% vs. 0%, p = 0.0023). However, regression analysis revealed that combined surgery did not predict either complication. There were no significant differences in the rates of CMO (6.5% [COMB] vs. 9% [SEQ], p = 0.1522) and recurrent ERM (2.1% [COMB] vs. 3.3% [SEQ], p = 0.2758) between both groups.

Conclusion

Both combined and sequential procedures are comparably effective and safe means for managing eyes with ERM.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow chart illustrating the filtering process used for data categorization into combined and sequential surgery pars plana vitrectomy and cataract surgery groups.

Similar content being viewed by others

Data availability

Data is available upon request from the corresponding author.

References

  1. da Silva RA, Roda VM, de P, Matsuda M, Siqueira PV, Lustoza-Costa GJ, et al. Cellular components of the idiopathic epiretinal membrane. Graefe’s Arch. Clin. Exp. Ophthalmol. 2021;260:1435–44.

    Article  Google Scholar 

  2. Xiao W, Chen X, Yan W, Zhu Z, He M. Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis of population-based studies. BMJ Open. 2017;7:e014644.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Meuer SM, Myers CE, Klein BEK, Swift MK, Huang Y, Gangaputra S, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography. Ophthalmology. 2015;122:787–95.

    Article  PubMed  Google Scholar 

  4. Kohno R, Hata Y, Kawahara S, Kita T, Arita R, Mochizuki Y, et al. Possible contribution of hyalocytes to idiopathic epiretinal membrane formation and its contraction. Br. J. Ophthalmol. 2009;93:1020–6.

    Article  PubMed  Google Scholar 

  5. Bu S-C, Kuijer R, Li X-R, Hooymans JMM, Los LI. Idiopathic epiretinal membrane. Retina. 2014;34:2317–35.

    Article  CAS  PubMed  Google Scholar 

  6. Chua PY, Sandinha MT, Steel DH. Idiopathic epiretinal membrane: progression and timing of surgery. Eye. 2021;36:495–503.

    Article  PubMed  PubMed Central  Google Scholar 

  7. PANOZZO G, PAROLINI B. Cataracts associated with posterior segment surgery. Ophthalmol. Clin. North Am. 2004;17:557–68.

    Article  PubMed  Google Scholar 

  8. Do DV, Gichuhi S, Vedula SS, Hawkins BS. Surgery for postvitrectomy cataract. Cochrane Database Syst. Rev. 2018;1:CD006366.

    PubMed  Google Scholar 

  9. Cheng L, Azen SP, El-Bradey MH, Scholz BM, Chaidhawangul S, Toyoguchi M, et al. Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study. Am. J. Ophthalmol. 2001;132:881–7.

    Article  CAS  PubMed  Google Scholar 

  10. Soliman MK, Hardin JS, Jawed F, Uwaydat SH, Faramawi MF, Chu CJ, et al. A database study of visual outcomes and intraoperative complications of postvitrectomy cataract surgery. Ophthalmology. 2018;125:1683–91.

    Article  PubMed  Google Scholar 

  11. Chiras D, Dervenis N, Dervenis P, Verma S. Phacoemulsification outcomes and complications in vitrectomised versus non-vitrectomised eyes. Clin. Exp. Optom. 2021;104:859–63.

    Article  PubMed  Google Scholar 

  12. Lundström M, Dickman M, Henry Y, Manning S, Rosen P, Tassignon M-J, et al. Cataract surgery of eyes with previous vitrectomy: risks and benefits as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J. Cataract Refract. Surg. 2020;46:1402–7.

    Article  PubMed  Google Scholar 

  13. Lyu J, Zhao P. Intraoperative posterior chamber irrigation to enhance vitreous cavity support during phacoemulsification cataract surgery after vitrectomy. J. Ophthalmol. 2020;2020:4132456.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hardin JS, Gauldin DW, Soliman MK, Chu CJ, Yang YC, Sallam AB. Cataract surgery outcomes in eyes with primary epiretinal membrane. JAMA Ophthalmol. 2018;136:148.

    Article  PubMed  Google Scholar 

  15. Seider MI, Michael Lahey J, Fellenbaum PS. Cost of Phacovitrectomy versus Vitrectomy and sequential phacoemulsification. Retina. 2014;34:1112–5.

    Article  PubMed  Google Scholar 

  16. Port AD, Nolan JG, Siegel NH, Chen X, Ness SD, Subramanian ML. Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification. Graefe’s Arch. Clin. Exp. Ophthalmol. 2021;259:45–52.

    Article  Google Scholar 

  17. Lee JY, Kim K-H, Shin KH, Han DH, Lee DY, Nam DH. Comparison of intraoperative complications of phacoemulsification between sequential and combined procedures of pars plana vitrectomy and cataract surgery. Retina. 2012;32:2026–33.

    Article  PubMed  Google Scholar 

  18. Erçalık NY, Yenerel NM, Sanisoğlu HA, Kumral ET, İmamoğlu S. Comparison of intra- and postoperative complications of phaco between sequential and combined procedures of 23-gauge vitrectomy and phaco. Saudi J. Ophthalmol. 2017;31:238–42.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Chung T-Y, Chung H, Lee JH. Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation. J. Cataract Refract. Surg. 2002;28:2001–5.

    Article  PubMed  Google Scholar 

  20. Hamoudi H, Correll Christensen U, La Cour M. Epiretinal membrane surgery: an analysis of 2-step sequential- or combined phacovitrectomy surgery on refraction and macular anatomy in a prospective trial. Acta Ophthalmol. 2018;96:243–50.

    Article  PubMed  Google Scholar 

  21. Elhusseiny AM, Soliman MK, Shakarchi AF, Fouad YA, Yang YC, Sallam AB. Visual outcomes and complications of combined versus sequential cataract surgery and pars plana vitrectomy: a multicenter database study. J Cataract Refract Surg. 2023;49:142–7.

  22. Farahvash A, Popovic MM, Eshtiaghi A, Kertes PJ, Muni RH. Combined versus sequential phacoemulsification and pars plana vitrectomy. Ophthalmol. Retin. 2021;5:1125–38.

    Article  Google Scholar 

  23. Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, Yang YC. Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmology. 2016;123:316–23.

    Article  PubMed  Google Scholar 

  24. Treumer F, Bunse A, Rudolf M, Roider J. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach. Graefe’s Arch. Clin. Exp. Ophthalmol. 2006;244:808–15.

    Article  Google Scholar 

  25. Armstrong RA. Is there a large sample size problem? Ophthalmic Physiol. Opt. 2019;39:129–30.

    Article  PubMed  Google Scholar 

  26. Ross AH, Donachie PHJ, Sallam A, Stratton IM, Mohamed Q, Scanlon PH, et al. Which visual acuity measurements define high-quality care for patients with neovascular age-related macular degeneration treated with ranibizumab? Eye. 2013;27:56–64.

    Article  CAS  PubMed  Google Scholar 

  27. Peter S, Isaak S, Barbara P. Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure. Ophthalmic Surg Lasers Imaging Retin. 1995;26:420–8.

    Article  Google Scholar 

  28. Sun Y, Zhou R, Zhang B. With or without internal limiting membrane peeling for idiopathic epiretinal membrane: A meta-analysis of randomized controlled trials. Retina. 2021;41:1644–51.

    Article  PubMed  Google Scholar 

  29. Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Surgical management, use and efficacy of adjuvant dyes in idiopathic epiretinal membranes: a systemic review with network meta-analysis. Int. J. Retin. Vitr. 2023;9:77.

    Article  Google Scholar 

  30. Elhusseiny AM, Flynn Jr HW, Smiddy WE. Long-term outcomes after idiopathic epiretinal membrane surgery. Clin. Ophthalmol. 2020;14:995–1002.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tan A, Bertrand-Boiché M, Angioi-Duprez K, Berrod J-P, Conart J-B. Outcomes of combined phacoemulsification and pars plana vitrectomy for rhegmatogenous retinal detachment. Retina. 2021;41:68–74.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt

    Yousef A. Fouad & Ahmed B. Sallam

  2. Department of Ophthalmology, Assiut University Hospitals, Assiut, Egypt

    Mohamed K. Soliman

  3. University Hospitals Eye Institute, Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, OH, USA

    Mohamed K. Soliman

  4. Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Abdelrahman M. Elhusseiny & Ahmed B. Sallam

  5. Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, UK

    Yit C. Yang

Authors
  1. Yousef A. Fouad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed K. Soliman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdelrahman M. Elhusseiny
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yit C. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ahmed B. Sallam
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YAF was responsible for data interpretation, reviewing the literature, and writing the initial draft. MKS was responsible for designing the study, data curation, statistical analysis, and revising the manuscript. AME provided critical feedback on the work. YCY was responsible for data curation and provided critical feedback on the work. ABS was responsible for conception of the idea, designing the study, and revising the manuscript. All authors reviewed and approved the final draft.

Corresponding author

Correspondence to Ahmed B. Sallam.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fouad, Y.A., Soliman, M.K., Elhusseiny, A.M. et al. Visual outcomes and complications of combined versus sequential pars plana vitrectomy and phacoemulsification for epiretinal membrane. Eye (2024). https://doi.org/10.1038/s41433-024-03004-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41433-024-03004-5

Search

Advanced search

Quick links