Comparison between sulcus-implanted three-piece hydrophobic intraocular lens and bagal-implanted single-piece intraocular lens in combined diabetic phacoemulsification and pars plana vitrectomy

Abstract

Background Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. In advanced stages of DR, vitreoretinal surgery frequently becomes necessary to preserve or restore vision. Patients with vitreoretinal diseases often present with preexisting lens opacification. In addition, cataract formation is a common complication of pars plana vitrectomy. Thus, combining vitrectomy with cataract removal has recently become a common practice. Still, limited studies exist on the efficacy of placing the intraocular lens (IOL) in the ciliary sulcus and its potential to reduce the complications associated with the IOL implanted in the bag. Objective The current study aimed to compare the sulcus-implanted three-piece hydrophobic IOL and the bagal-implanted single-piece hydrophobic IOL in combined diabetic phacoemulsification with pars plana vitrectomy in diabetic eyes. Patients and methods This is a prospective interventional comparative study of the eyes for which phaco-vitrectomy was performed for the complications of DR. The eyes were equally randomized according to the indication for surgery and the severity of the disease into two groups, group 1: phaco-vitrectomy with hydrophobic acrylic three-piece sulcus IOL (60 eyes of 35 patients) and group 2: phaco-vitrectomy with hydrophobic acrylic one-piece in the bag IOL (57 eyes of 38 patients). We excluded eyes with other concomitant pathologies. All study participants were evaluated by visual acuity assessment, intraocular pressure (IOP) measurement, optical or ultrasound biometry, and optical coherence tomography. The cases were followed up for 3 months or more postoperatively. Results The study included 117 eyes of 73 patients, of whom 58.9% were females with a mean age of 47.71±15.37 years. The two groups were comparable in terms of preoperative assessment. Compared to group 2, group 1 was associated with significantly better mean best-corrected visual acuity (0.4 vs. 0.6 LogMAR, P <0.001) and lower mean IOP (19.0 vs. 23.6 mmHg, P <0.001). Regarding the postoperative complications, group 1 had significantly lower rates of posterior synechia at a single site than group 2 (3.3 vs. 24.6%, respectively, P =0.002) and posterior synechia at more than a single site (0 vs. 14%, respectively, P =0.008). Ring synechia was observed in four cases, all of whom were in group 2 (7%, P =0.11). Given the safer and better outcome of group 1, this group was less commonly prescribed antiglaucoma drugs, and none of them required iridotomy ( P <0.05). Conclusion The three-piece sulcus IOL proved to be superior over the single-piece IOL in the capsular bag technique in terms of visual acuity, IOP, improved visual outcome, and fewer postoperative complications.