Título / Title

COMBINED PARS PLANA VITRECTOMY (PPV) AND PHACOEMULSIFICATION (PHACO) VERSUS PPV AND DEFERRED PHACO FOR PATIENTS WITH MACULAR HOLE: ONE-YEAR OUTCOMES

Introdução / Purpose

To compare outcomes for combined pars plana vitrectomy (PPV) and phacoemulsification (phaco), versus PPV and deferred phaco in patients with macular hole (MH) without dense cataract.

Material e Método / Methods

Sixty-five patients (65 eyes) with MH with lens opacity less than grade II cortical/nuclear (LOCS III) were randomly assigned to: Group I (PHACO + PPV) or Group 2 (PPV with deferred PHACO). Comprehensive ophthalmologic evaluation performed at baseline and at 1, 3, 6, 9, and 12 months following PPV included ETDRS best-corrected visual acuity (BCVA); intraocular pressure (IOP), MH height, internal basal diameter (IB) and external basal diameter (EB) measured by spectral domain optical coherence tomography (OCT) (Heidelberg, Germany); microperimetry assessment of macular sensitivity (MAIA, Italy); and specular microscopy (Konan Medical Inc., USA). In Group 2, phaco was performed at any time post-PPV if the cataract severity was LOCS subcapsular ≥1 or nuclear ≥3 or cortical ≥3, or if any decrease in visual acuity attributable to the cataract.

Resultados / Results

A total of 65 patients (33 in Group 1 and 32 in Group 2) completed 12 months of follow-up. Mean ± SE BCVA (logMAR) was 0,92 ± 0,04 and 0,90 ± 0,04 at baseline and improved significantly to 0,60 ± 0,05 and 0,58 ± 0,05 at month 12 (p<0.0001) in Groups 1 and 2, respectively. There was no significant difference between the groups for IOP or endothelial cell density at baseline or at 12 months. There was also no difference between the groups in baseline mean MH height, IB and EB. MH closure rate was 72% and 75% in groups 1 and 2, respectively (p = 0,834, chi-square test). Mean macular sensitivity (dB) was 18,2 ± 0,9 and 16,7 ± 0.9 at baseline and increased to 21.13 ± 0.86 and 21.07 ± 0.85 in groups 1 and 2, respectively (p <0.05) without difference between the groups (p=0.449).

Discussão e Conclusões / Conclusion

Combined PPV and phaco was associated with similar BCVA outcomes at 1 year when compared to PPV and deferred phaco in patients with MH.

Palavras Chave

Macular Hole; combined surgery, phacoemulsification, vitrectomy, ILM peeling.