Transcript
[00:00:00]
Welcome to the New Retina Radio Journal Club with VBS. My name is Vaidehi Dedania from NYU Langone Health. I'm joined today by Dr. Yewlin Chee from the University of Washington in Seattle.
Hi, all.
And Dr. Joshua Uhr from Mid-Atlantic Retina and Wills Eye Hospital in Philadelphia.
Hi, thanks for having me.
Today, we're discussing a paper titled Phacovitrectomy versus Vitrectomy for Primary Rhegmatogenous Retinal Detachment in Phakic Eyes by Melissa Gough, et al. It was published in Ophthalmology Retina in July 2026. Dr. Uhr, would you like to get us started with a summary?
So the aim of this study was to compare anatomic and visual outcomes following surgical intervention by pars plana vitrectomy or phacovitrectomy for phakic patients with primary rhegmatogenous retinal detachment.
[00:01:00]
It was a multicenter propensity score-matched cohort study from a large database of vitreoretinal surgeons in the United Kingdom and Ireland. Cases were collected from two thousand and eight to two thousand and twenty-four, and patients with retinal detachment were excluded if they had either silicone oil or perfluorocarbon liquid tamponade; secondary detachments, for example, from trauma, syndromes, uveitis, et cetera; reoperations; if there was a concurrent macular hole; if a scleral buckle was placed; if a relaxing retinectomy was performed; if there was follow-up less than eight weeks; or if there was coexisting pathology that affected vision.
About sixty-one hundred eyes were used to assess anatomic outcomes, and about forty-seven hundred eyes were used to assess visual outcomes. Anatomic success was greater than ninety percent in both the phacovitrectomy and the vitrectomy groups, with no statistically significant differences in anatomic success observed.
[00:02:00]
For vision, phacovitrectomy was associated with better vision than vitrectomy by about roughly three ETDRS letters. But this was attenuated after accounting for baseline cataract and restricting the analysis to pseudophakic eyes only. Cystoid macular edema was more common in the phacovitrectomy group at a rate of one point nine four percent compared to zero point three five percent, but other complications were uncommon in both groups.
So the authors conclude that phacovitrectomy and vitrectomy result in similar anatomic outcomes for rhegmatogenous retinal detachment, and the visual benefit for phacovitrectomy may be lens-related and not a measure of improved retinal outcomes.
Great. Thank you, Dr. Uhr. Dr. Chee, any thoughts on this?
Well, I think it's great to see that there's really good anatomic success in both groups. And I think, as US surgeons, it's always interesting to hear about kind of different practice patterns.
[00:03:00]
I know our European colleagues are more apt to do phacovitrectomies in general. But I guess the question this tries to answer is, you know, is there a group of surgeons who, you know, might want to do phacovitrectomy in this situation, but might not because they're concerned about safety?
And I'm not quite sure how large of a group of surgeons that cohort would be, quite frankly. Certainly in the US.
Yeah.
So I don't know if it will particularly change our practice patterns here.
Do you think that, seeing these results, there may be some surgeons who will be more inclined to performing phacovitrectomies, where previously they hadn't thought about it as necessarily not affecting the outcomes or having zero impact, or maybe even negatively impacting the outcomes?
[00:04:00]
Yeah, I mean, I think that there are probably more surgeons here that might be concerned about a negative impact to outcomes. I think you're worried about with more surgery, could more things happen, right? Could there be more inflammation, for example, and influence your outcomes? But I don't know, again, in the US, because there's so much that goes into whether or not you're the one doing the phaco, including referral patterns and what we're comfortable doing in general.
Mm-hmm.
I don't know if this is really gonna change what we do here necessarily.
Dr. Uhr, any other thoughts?
Yeah, I agree completely. I have heard other US-based surgeons cite the concern for inflammation as a reason to not do a phacovitrectomy.
[00:05:00]
So I agree that it's reassuring to have data that shows that the outcomes are similar, but because of, as Dr. Chee said, practice patterns and what many vitreoretinal surgeons are comfortable doing and what tools and instruments we even have access to in the OR, I doubt that this is gonna move the needle and inspire more US-based surgeons to do phacovitrectomy for retinal detachment.
So, does the three-letter benefit favoring phaco surprise you? We can start with Dr. Chee.
I mean, it doesn't really surprise me. I think we're looking at patients who might have had some cataract before, right? And are getting cataract surgery at time of their retinal detachment repair. I think the group does a pretty good job of trying to control for that by looking at patients in their subanalysis who had fovea-on detachments, who were made pseudophakic at the time of their retinal detachment repair versus those who were made pseudophakic after their retinal detachment repair and they didn't really find much difference between their visual acuity outcomes.
[00:06:00]
So it really doesn't surprise me.
Okay. Assuming all things are equal, which they sort of were in the study, sparing some ETDRS data and CME outcomes, does this simply mean that we have two good options on the table? I can field that to you, Dr. Uhr.
Yeah. Sure. Yeah, I do think that's what it means.
I personally reserve phacovitrectomy for cases where the phaco needs to be done in order to have an adequate surgical view. So it's just not my practice pattern to routinely do phacovitrectomy. But I think both are reasonable options, and this study confirms for us that patients do well and have great outcomes no matter which approach you take.
So I think it's partly patient-dependent and surgeon-dependent, and they both work.
Anything to add, Dr. Chee? Any other indications for which you utilize phacovitrectomy right now, or not really?
[00:07:00]
I do a fair number of phacovitrectomies, but usually not in the setting of retinal detachment. I would do a phacovitrectomy for like an ERM or a mac hole.
You know, for patients with particularly challenging retinal detachments with a lot of PVR, I'm probably more apt to do just a pars plana lensectomy and take capsule and address the lens issue later down the line rather than do a phaco.
Mm-hmm. Now, these data cover a long period of time from 2008 to 2024. So how have phaco and pars plana vitrectomy changed in that time? And do you think it's now safer or more effective than before?
I think the technology's changed a lot, both in terms of the phaco and the vitrectomy. I wonder how many, for example, of our surgical mentors trained when phaco was not quite as benign, right? And caused more inflammation, and therefore have taught us to be concerned about that potential complication.
[00:08:00]
But I think now, you know, with the newer systems, phaco is really quite safe. Vitrectomy is safer as well with small-gauge instrumentation, but also, like, better visualization systems.
So, you know, some old-school surgeons may have been quicker to take a lens out 'cause they were concerned about their ability to get peripheral vitreous. And I think with modern visualization systems that we have, you can do a pretty good job and leave the lens in place. Even for, you know, cases like GRTs, I think most of us probably don't routinely take out the lens, but some older surgeons do.
For phacovitrectomies, you know, with cases with the RDs, there's the logistics of it, too, right? So you need to figure out which lens to insert. You know, when are you getting your pre-op measurements, and how accurate are they?
Mm-hmm.
Those are all things that would need to be hashed out.
Yeah.
[00:09:00]
And then, are there surgeons who are doing the vitrectomy? Are they coordinating with another surgeon who is doing the phacoemulsification? And how easy is that to coordinate and get into the OR at the same time for this fovea-on retinal detachment? Any lingering questions you might have, Dr. Chee, after reading this article?
I'd be interested to know how many of the surgeons that are doing the phacovitrectomies, is that kind of their go-to move, right? Or do they have patients in both cohorts? It strikes me that they're probably just surgeons that tend to do phacovitrectomies, but it'd be good to know.
Mm-hmm. And any lingering questions for you, Dr. Uhr?
I would be really curious to know, to a point that you already alluded to, how this works logistically. People who are doing this, are they doing their own phacos, or are they doing them as combination surgeries with their anterior segment colleagues? Because it does make a big difference in your ability to do these cases in a timely manner.
[00:10:00]
Well, I'd like to thank the audience for listening to the New Retina Radio Journal Club with VBS, and stay tuned for further episodes.
