Comparative Outcomes of Pars Plana Vitrectomy Versus Combined Vitrectomy With Phacoemulsification in Proliferative Diabetic Retinopathy and Cataract

Background Proliferative diabetic retinopathy (PDR) often requires pars plana vitrectomy (PPV) for complications such as vitreous hemorrhage and tractional retinal detachment. Cataract progression following PPV is common, and the role of combined PPV with cataract extraction (PPVCE) remains debated. This study aimed to compare visual outcomes and post-operative complications between PPV alone and PPVCE in patients with PDR and coexisting cataract. Methods This retrospective observational study was conducted at Hospital Sultanah Bahiyah, Kedah, Malaysia, and included diabetic patients with PDR and coexisting cataract who underwent either PPV alone or PPVCE. Pre-operative and post-operative data were collected, including best-corrected visual acuity (BCVA) and post-operative complications. The main outcome measures were a change in BCVA and the incidence of post-operative complications. Comparative statistical analyses were performed between the two groups. Results A total of 115 eyes were evaluated (PPV=43; PPVCE=72), with a mean follow-up period of 1.27 years. The PPVCE group was significantly older than the PPV group (49.22 vs 43.30 years, p=0.01). Both groups demonstrated improvement in BCVA, with no significant between-group difference in final BCVA at last follow-up (p=0.44). Significant visual improvement was observed in vitreous hemorrhage (VH) cases compared to tractional retinal detachment (TRD). Notably, 48.8% of patients in the PPV-alone group required subsequent cataract extraction during follow-up. There were no significant differences in complication rates, including ocular hypertension and neovascular glaucoma, between the two groups (p=0.33 and p=0.53, respectively). Conclusion PPV and PPVCE provide comparable visual and safety outcomes in patients with PDR and cataracts. However, the high rate of subsequent cataract surgery following PPV alone suggests that a combined approach may reduce the need for re-operations and improve overall patient management in appropriately selected patients.