Staged surgical treatment of patients of proliferative diabetic retinopathy and complicated primary cataract as a variant of sparing surgery: justification and remote results

Purpose. To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients. Material and methods. 187 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into four groups depending on the treatment tactics. In the 1st group patients were subjected to a two-step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the 3rd group patients were subjected to a two-step surgical procedure: vitreoretinal surgery with gas tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and the IOL implantation. In the 4th group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with gas tamponade. Results: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along on PDR patients with complicated primary cataract. Conclusions: This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.