Diabetic Vitrectomy. Influence of Lens Status upon Anatomic and Visual Outcomes

Objective: To determine the effect of lens status upon the anatomic and visual results in primary diabetic vitrectomy. Design: Retrospective, comparative, consecutive case series. Participants: One hundred two eyes of 85 patients with proliferative diabetic retinopathy and its complications that underwent primary vitrectomy. Methods: The eyes that remained phakic after vitrectomy were compared with the eyes that were either aphakic or pseudophakic (nonphakic) postoperatively. Main Outcome Measures: Intraoperative and postoperative complications, vitreoretinal reoperation rate, and ultimate anatomic and visual success with at least 6 months' follow-up. Results: Preoperatively, 72 eyes were phakic, and 30 were aphakic (n = 1) or pseudophakic (n = 29). During vitrectomy, 1 eye underwent lensectomy and 12 eyes underwent phacoemulsification with lens implantation. Postoperatively, 59 eyes were phakic and 43 eyes were nonphakic. The vitreoretinal reoperation rate was significantly higher (P = 0.04) for the phakic group (28.8%) than for the nonphakic group (11.6%). Rubeosis iridis developed in 3 phakic eyes and no nonphakic eyes (P = 0.26). Intraoperative complications were similar in the phakic and nonphakic groups (P = 0.40). Postoperative complications such as rhegmatogenous retinal detachment (P = 0.39), nonclearing vitreous hemorrhage (P = 0.07), and anterior chamber complications (P = 0.60) were also similar. Visual acuity improved by at least 0.2 logarithm of the minimum angle of resolution units in 76.2% of the phakic eyes and 86.0% of the nonphakic eyes (P = 0.22). Conclusions: Eyes that were phakic after primary diabetic vitrectomy had a significantly higher subsequent vitreoretinal reoperation rate when compared with nonphakic eyes, suggesting that diabetic eyes are less likely to require additional vitreoretinal surgery if they are rendered nonphakic before or during vitrectomy.