Postoperative Outcomes in Combined Phacovitrectomy vs Vitrectomy Alone in Severe Diabetic Retinopathy

Abstract

Purpose: To assess differences in postoperative outcomes between combined phacovitrectomy and vitrectomy alone in patients undergoing surgery for complications of proliferative diabetic retinopathy (PDR). Methods: This retrospective analysis examined patients with PDR undergoing pars plana vitrectomy (PPV) at Boston Medical Center between 2019 and 2025. Patients were stratified by lens status and surgical approach (group 1 = phakic lens and PPV alone [n = 303]; group 2 = pseudophakic lens and PPV alone [n = 118]; group 3 = combined cataract extraction with intraocular lens and PPV, or phacovitrectomy [n = 198]). Outcomes included postoperative hemorrhage and postoperative complications within 90 days of surgery. Logistic regression was performed to evaluate the association between study group and outcomes, adjusting for relevant confounders. Results: A total of 619 eyes of 562 patients with PDR and an indication for PPV (nonclearing vitreous hemorrhage or tractional retinal detachment [TRD]) were included. Univariate analysis revealed that age, hypertension, perioperative bevacizumab use, TRD, intraoperative tamponade type, and operative status were associated with greater odds of experiencing postoperative complications and hemorrhage. After adjusting for confounders, multivariate analyses showed that group 3 patients (combined phacovitrectomy) had lower odds of postoperative complications (odds ratio [OR], 0.646 [95% CI, 0.439–0.952]; P = .027) and hemorrhage (OR, 0.640 [95% CI, 0.433–0.943]; P = .036) compared with group 1 patients (phakic vitrectomy), but group 2 patients (pseudophakic vitrectomy) did not have significantly decreased odds of either outcome. Conclusions: Patients undergoing combined phacovitrectomy have decreased odds of experiencing postoperative complications and hemorrhage within 90 days of surgery, compared with patients with phakic lens undergoing PPV alone. Lens removal at the time of vitrectomy for patients with PDR may reduce postoperative complication risk.