Prospective Comparison of Intraocular Lens Dynamics and Refractive Error between Phacovitrectomy and Phacoemulsification Alone.

PURPOSE: To compare intraocular lens (IOL) dynamics and refractive prediction errors between eyes that underwent phacovitrectomy and eyes that underwent phacoemulsification alone. DESIGN: Prospective, nonrandomized, comparative, observational study. PARTICIPANTS: Sixty eyes of 60 patients who underwent 25-gauge phacovitrectomy without gas injection for macular pathology and 60 eyes of 60 patients who underwent phacoemulsification alone for cataract were enrolled. METHODS: Preoperative optical biometry was performed using the IOLMaster 700 (Carl Zeiss Meditec, Inc, Dublin, CA) to calculate the IOL power with the Barrett Universal II formula. Monofocal, nontoric, single-piece foldable aspherical IOLs were implanted in each patient. Comprehensive ocular examinations, including CASIA2 (Tomey Corp, Nagoya, Japan) evaluations of the preoperative crystalline lens and postoperative IOL positions (i.e., decentration, tilt, and aqueous depth), were performed before and 3 days, 1 month, and 3 months after surgery. MAIN OUTCOME MEASURES: Refractive prediction errors and IOL dynamics. RESULTS: Mean refractive prediction errors at 3 days, 1 month, and 3 months after phacovitrectomy were 0.51+/-0.59 diopters (D), 0.11+/-0.40 D, and 0.05+/-0.41 D, respectively, whereas those after phacoemulsification alone were 0.43+/-0.38 D, 0.11+/-0.37 D, and 0.07+/-0.34 D, respectively. There was no significant difference in the refractive error between the 2 groups at any time point. A myopic shift of -0.50 D or more negative refractive error occurred in 4 (6.7%) of 60 eyes with phacovitrectomy and 3 (5.0%) of 60 eyes with phacoemulsification alone; there was no significant between-group difference. At 3 months postoperatively, refractive errors within +/-0.50 D and +/-1.00 D were achieved in 49 (81.7%) and 58 (96.7%) of 60 eyes in the phacovitrectomy group and 52 (86.7%) and 60 (100.0%) of 60 eyes in the phacoemulsification alone group, again without any significant between-group differences. There were no significant differences in the preoperative lens and postoperative IOL positions between the 2 study groups, except for a significantly deeper mean aqueous depth at 3 days after surgery in the phacovitrectomy group. CONCLUSIONS: Neither myopic shift nor IOL displacement occurs after 25-gauge phacovitrectomy with a single-piece IOL without gas injection for macular pathology compared with phacoemulsification alone.