Combined versus Sequential Phacoemulsification and Pars Plana Vitrectomy

A Meta-Analysis
Published:January 19, 2021DOI:


      It is unclear whether differences exist in efficacy and safety between combined versus sequentially performed phacoemulsification and pars plana vitrectomy (phaco-PPV).

      Clinical Relevance

      This meta-analysis aimed to compare the efficacy and incidence of complications between these surgical methods.


      Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched for articles reporting the efficacy and safety of combined versus sequential phaco-PPV for any indication. The primary outcomes were postoperative best-corrected visual acuity (BCVA) and mean absolute refractive error from target (RET). Secondary outcomes included efficacy outcomes and postoperative complications. Meta-analysis was conducted using a random effects model in all cases. Risk of bias assessment was performed using the Cochrane risk of bias assessment tool for randomized trials and ROBINS-I tool for observational studies.


      Of the 5410 articles identified, 1 randomized controlled trial and 14 comparative studies were included, with 1407 and 951 eyes in the combined and sequential surgery groups, respectively. Mean age was 62.71 ± 6.16 years and 44% (range, 32.1%–70%) of eyes were from men. The mean baseline BCVA was 0.88 ± 0.59 logarithm of the minimum angle of resolution units (Snellen equivalent, 20/152). The meta-analysis showed no significance between groups in postoperative mean BCVA (P = 0.76) and mean absolute RET (P = 0.46). The risks of synechiae formation (risk ratio [RR], 2.74; 95% confidence interval [CI], 1.83–4.11; P < 0.001), fibrin formation (RR, 2.81; 95% CI, 1.84–4.30; P < 0.001), and intraoperative or postoperative retinal detachment (RR, 2.65; 95% CI, 1.08–6.47; P = 0.03) were significantly higher after combined surgery. However, the risks of posterior capsular tear (RR, 0.43; 95% CI, 0.25–0.73; P = 0.002) and macular hole nonclosure or reopening (RR, 0.18; 95% CI, 0.03–0.93; P = 0.04) were significantly lower in the combined group.


      No significant differences were found in visual and refractive outcomes between combined and sequential phaco-PPV, whereas differences existed in certain safety outcomes. These conclusions remain preliminary, as most evidence is derived from low- to moderate-quality retrospective studies. Given the variability in outcome reporting and associated heterogeneity, future randomized controlled trials are needed.


      Abbreviations and Acronyms:

      BCVA (best-corrected visual acuity), CI (confidence interval), D (diopter), ERM (epiretinal membrane), GRADE (Grading of Recommendations, Assessment, Development and Evaluation), IOP (intraocular pressure), MH (macular hole), PPV (pars plana vitrectomy), RCT (randomized controlled trial), RD (retinal detachment), RR (risk ratio), VH (vitreous hemorrhage)
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