Anna Hillenmayer, Christian M Wertheimer, Susanna F Koenig, Lennart M Hartmann, Tim Freisenich, Dorian Begaj, Armin Wolf, Efstathios Vounotrypidis
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Although an optical biometer can be used to calculate the required dioptric power of the intraocular lens, loss of central fixation can introduce errors into the biometric parameters.</p><p><strong>Design: </strong>Retrospective single-center observational study.</p><p><strong>Methods: </strong>Patients with retinal detachment and cataract who underwent combined phacoemulsification and vitrectomy following swept-source optical coherence tomography-based biometry (ZEISS IOLMaster 700) were included, and their preoperative macular status, chord-alpha length, and resulting refractive error at the final follow-up appointment were recorded.</p><p><strong>Results: </strong>A total of 305 eyes were evaluated, of which 150 had macular detachment. There was a statistically significantly higher rate of refractive error in eyes with macular detachment compared to eyes without (<i>p</i> < 0.001). Absolute refractive prediction error of more than 1 diopter was found in 31% of eyes with detached maculae, compared to 12% of eyes without macular involvement. Eyes with a detached macula showed a significantly longer chord alpha (right eye: <i>p</i> = 0.01; left eye: <i>p</i> < 0.0001), and linear regression analysis revealed that a longer chord alpha was associated with a myopic refractive error. The presence of other factors that also correlated with refractive error underscores the multifactorial pathogenesis of refractive prediction error.</p><p><strong>Conclusions: </strong>Compared to non-macular involvement, macular detachment led to worse refractive outcomes in combined phacovitrectomy, and chord alpha, as a marker for central fixation, might serve as an explanation. Further research is needed to determine whether combined phacoemulsification and vitrectomy should be performed in patients with macular detachment.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":"17 ","pages":"25158414251378632"},"PeriodicalIF":2.3000,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501455/pdf/","citationCount":"0","resultStr":"{\"title\":\"Combined phacovitrectomy for retinal detachment and cataract-macular attachment and visual fixation as predictors of postoperative refractive error.\",\"authors\":\"Anna Hillenmayer, Christian M Wertheimer, Susanna F Koenig, Lennart M Hartmann, Tim Freisenich, Dorian Begaj, Armin Wolf, Efstathios Vounotrypidis\",\"doi\":\"10.1177/25158414251378632\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background/objectives: </strong>To evaluate the effect of macular status and fixation, as determined by chord alpha, on refractive outcomes following combined phacovitrectomy for retinal detachment. Although an optical biometer can be used to calculate the required dioptric power of the intraocular lens, loss of central fixation can introduce errors into the biometric parameters.</p><p><strong>Design: </strong>Retrospective single-center observational study.</p><p><strong>Methods: </strong>Patients with retinal detachment and cataract who underwent combined phacoemulsification and vitrectomy following swept-source optical coherence tomography-based biometry (ZEISS IOLMaster 700) were included, and their preoperative macular status, chord-alpha length, and resulting refractive error at the final follow-up appointment were recorded.</p><p><strong>Results: </strong>A total of 305 eyes were evaluated, of which 150 had macular detachment. There was a statistically significantly higher rate of refractive error in eyes with macular detachment compared to eyes without (<i>p</i> < 0.001). Absolute refractive prediction error of more than 1 diopter was found in 31% of eyes with detached maculae, compared to 12% of eyes without macular involvement. Eyes with a detached macula showed a significantly longer chord alpha (right eye: <i>p</i> = 0.01; left eye: <i>p</i> < 0.0001), and linear regression analysis revealed that a longer chord alpha was associated with a myopic refractive error. The presence of other factors that also correlated with refractive error underscores the multifactorial pathogenesis of refractive prediction error.</p><p><strong>Conclusions: </strong>Compared to non-macular involvement, macular detachment led to worse refractive outcomes in combined phacovitrectomy, and chord alpha, as a marker for central fixation, might serve as an explanation. 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引用次数: 0
摘要
背景/目的：评估由alpha弦确定的黄斑状态和固定对联合晶状体切除术治疗视网膜脱离后屈光结果的影响。虽然光学生物计可以用来计算人工晶状体所需的屈光度，但失去中心固定会给生物特征参数带来误差。设计：回顾性单中心观察性研究。方法：纳入经扫描源光学相干断层扫描生物测量术（ZEISS IOLMaster 700）行超声乳化联合玻璃体切除术的视网膜脱离合并白内障患者，记录其术前黄斑状态、α线长度和最终随访时的屈光不正。结果：共检查305只眼，其中黄斑脱离150只眼。有黄斑脱离的眼屈光不正发生率明显高于无黄斑受累的眼（p p = 0.01；左眼：p）。结论：与无黄斑受累的眼相比，黄斑脱离导致联合晶状体切除术的屈光结果更差，alpha弦作为中心固定的标志可能是一个解释。黄斑脱离患者是否应行超声乳化联合玻璃体切除术，尚需进一步研究。
Combined phacovitrectomy for retinal detachment and cataract-macular attachment and visual fixation as predictors of postoperative refractive error.
Background/objectives: To evaluate the effect of macular status and fixation, as determined by chord alpha, on refractive outcomes following combined phacovitrectomy for retinal detachment. Although an optical biometer can be used to calculate the required dioptric power of the intraocular lens, loss of central fixation can introduce errors into the biometric parameters.
Methods: Patients with retinal detachment and cataract who underwent combined phacoemulsification and vitrectomy following swept-source optical coherence tomography-based biometry (ZEISS IOLMaster 700) were included, and their preoperative macular status, chord-alpha length, and resulting refractive error at the final follow-up appointment were recorded.
Results: A total of 305 eyes were evaluated, of which 150 had macular detachment. There was a statistically significantly higher rate of refractive error in eyes with macular detachment compared to eyes without (p < 0.001). Absolute refractive prediction error of more than 1 diopter was found in 31% of eyes with detached maculae, compared to 12% of eyes without macular involvement. Eyes with a detached macula showed a significantly longer chord alpha (right eye: p = 0.01; left eye: p < 0.0001), and linear regression analysis revealed that a longer chord alpha was associated with a myopic refractive error. The presence of other factors that also correlated with refractive error underscores the multifactorial pathogenesis of refractive prediction error.
Conclusions: Compared to non-macular involvement, macular detachment led to worse refractive outcomes in combined phacovitrectomy, and chord alpha, as a marker for central fixation, might serve as an explanation. Further research is needed to determine whether combined phacoemulsification and vitrectomy should be performed in patients with macular detachment.
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