Assessing Refractive Outcomes and Accuracy of Biometry in Phacovitrectomy and Sequential Operations in Patients With Retinal Detachment Compared With Routine Cataract Surgery

PURPOSE: To compare refractive outcomes and accuracy of modern optical biometry, swept-source optical coherence tomography, ultrasound biometry, and effect of the macula status in rhegmatogenous retinal detachment managed with either combined phacovitrectomy or sequential vitrectomy and cataract surgery compared with a control, phacoemulsification alone. METHODS: Retrospective, comparative, consecutive study of 154 eyes; Group 1 underwent phacovitrectomy (n: 70), Group 2 underwent vitrectomy with subsequent cataract surgery (n: 41), and Group 3 underwent cataract surgery alone (n: 43). RESULTS: No difference in the mean absolute error was found between Group 2 (0.41 ± 0.56) and Group 3 (0.41 ± 0.29); both were superior to Group 1 (0.74 ± 0.57). Between Group 1 and Group 2, no statistically significant difference in the mean absolute error was found between macula-on subgroups (P = 0.057), but this was statistically significant between macula-off subgroups (P = 0.009). Subgroup analysis by biometry showed that the difference in the mean absolute error between macula-off optical biometry Group 1 and Group 2 against our control, Group 3, were not significant (P = 0.078 and P = 0.119, respectively); the mean absolute error was significantly different when considering macula-off ultrasound biometry cases (P < 0.001 and P = 0.038, respectively). CONCLUSION: All three groups had comparable refractive outcomes when using optical biometry. However, phacovitrectomy macula-off cases had inferior refractive outcomes when the ultrasound biometry had to be used. In macula-off rhegmatogenous retinal detachment, when optical biometry is not reliable, it is preferable to perform sequential surgery rather than phacovitrectomy.