Scientists analyzed the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy, as part of a retrospective, multicenter database study. They included eyes that underwent phacoemulsification between June 2005 and March 2015 at eight sites in the United Kingdom.

Study eyes were classified as vitrectomized (prior PPV group) or non-vitrectomized depending on the vitreous state at the time of cataract surgery. They excluded eyes with multiple intraocular surgeries or history of ocular diseases known to cause cataract progression or increased risk of intraoperative complications during phacoemulsification. Main outcome measures included logMAR, visual acuity, rate of intraoperative complications and time interval to cataract surgery.

Eyes in the prior PPV group (n=2,221) compared with the non-vitrectomized group:
• had worse preoperative logMAR VA (0.96 ±0.60 vs. 0.62 ±0.52, p<0.0001);
• were younger;
• had longer axial lengths than the nonvitrectomized group (n=136,533);
• had poorer mean vision (0.41 ±0.47 vs. 0.17 ±0.29 at four to 12 weeks p<0.0001) at all postoperative time points measured up to 24 weeks;
• and had a smaller proportion of eyes achieving postoperative VA ≤0.30 logMAR (Snellen, ≥20/40) (60.8 percent vs. 86.5 percent at four to 12 weeks, p<0.0001).

The rate of posterior capsular rupture was not different between prior PPV (1.5 percent) and non-vitrectomized (1.7 percent) groups, but the incidences of zonular dialysis (1.3 percent vs. 0.6 percent) and dropped nuclear fragments (0.6 percent vs. 0.2 percent) were higher in the prior PPV group (p<0.0001). The mean time interval between PPV and cataract surgery was 399 days.

Scientists found significant VA improvements with post-vitrectomy cataract surgery, but eyes exhibited worse mean postoperative vision of 0.2 logMAR units, a higher rate of zonular dialysis and dropped nuclear fragments, and a similar rate of posterior capsule rupture compared with eyes without prior PPV.

Researchers assessed real-world visual acuity outcomes of anti-vascular endothelial growth factor therapy for diabetic macular edema. They performed a retrospective analysis on the Vestrum Health Retina Database of aggregated, longitudinal electronic medical records from a geographically and demographically diverse sample of cases of U.S. retina specialists.

Participants included DME eyes that underwent ≥3 monthly anti-VEGF injections within four months of the first injection (between January 2011 and March 2017) with follow-up data prior to March 2018.

The eyes were divided into three groups based on initial intravitreal anti-VEGF agents (aflibercept, bevacizumab or ranibizumab). These eyes were subdivided into three cohorts by length of follow-up (six, 12 or 24 months), with each cohort being mutually exclusive. Researchers assessed VA outcomes and number of treatments on each cohort, and stratified the results by baseline VA. A total of 15,608 DME eyes were included.

In the 12-month cohort, of 1,379 eyes initially treated with aflibercept:
• the mean 12-month improvement was +5.5 letters (CI, +4.5 to +6.6 letters, p<0.001) after 7.5 injections on average, with similar outcomes for bevacizumab (3,109 eyes, +5.5 letters; CI, +4.7 to +6.3 letters, p<0.001, average 7.9 injections) and ranibizumab (1,352 eyes, +4 letters; CI, +2.9 to +5.2 letters, p<0.001, average 7.7 injections).

The mean numbers of corticosteroid, and macular and panretinal laser treatment sessions were similar in each group. In the 12-month cohort, when stratified by baseline VA:
• in the aflibercept group, the final mean letters gained or lost were: +28 (20/201 or worse); +10.2 (20/71 to 20/200); +2.8 (20/41 to 20/70); and -2.5 (20/40 or better);
• in the bevacizumab group, the final mean letters gained or lost were: +36 (20/201 or worse); +7.8 (20/71 to 20/200); +2.9 (20/41 to 20/70); and -2 (20/40 or better) letters; and
• in the ranibizumab group, the final mean letters gained or lost were: +30.5 (20/201 or worse); +7.9 (20/71 to 20/200); +1.6 (20/41 to 20/70); and -2.7 (20/40 or better).

Researchers concluded real-world VA outcomes following anti-VEGF therapy for DME were meaningfully inferior to those noted in randomized, controlled trials. They added that eyes with better baseline VA gained fewer letters compared with those with worse baseline VA and that the initial choice of anti-VEGF agent didn’t correlate with visual outcomes.