Efficacy of combined 25-gauge microincision vitrectomy, intraocular lens implantation, and posterior capsulotomy

PURPOSE: To evaluate the efficacy of combined 25-gauge microincision vitrectomy surgery, intraocular lens (IOL) implantation, and posterior capsulotomy. SETTING: Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan. DESIGN: Comparative case series. METHOD: The medical records of eyes that had 25-gauge microincision vitrectomy and IOL implantation without posterior capsulotomy (June 2009 to May 2010) or with posterior capsulotomy (June 2010 to May 2011) were reviewed. Outcomes measured were corrected distance visual acuity (CDVA) at 1 and 6 months, the rate of neodymium:YAG (Nd:YAG) laser capsulotomies for postoperative posterior capsule opacification (PCO), and the rate of surgical complications. RESULTS: The records of 343 eyes were reviewed; 136 eyes did not have a posterior capsulotomy, and 207 eyes had a posterior capsulotomy. There was a significant difference in the rate of Nd:YAG capsulotomy between the no-capsulotomy group (18 eyes, 13.2%) and the capsulotomy group (2 eyes, 1.0%) (P<.01). The mean CDVA improved postoperatively in both groups (P<.01); in 20 patients with postoperative PCO, the mean CDVA improved after Nd:YAG capsulotomy (P<.05). Intraoperatively, gas leaked into the anterior chamber in 5 (6.3%) of 79 eyes in the capsulotomy group that required fluid-air exchange. CONCLUSIONS: Combined 25-gauge microincision vitrectomy, IOL implantation, and posterior capsulotomy was safe and reduced the need for postoperative Nd:YAG capsulotomy. Posterior capsulotomy should be performed with caution in eyes that are expected to require intraoperative fluid-air exchange.