Surgical method selection for cataracts after pars plana vitrectomy in high myopia: comparison between femtosecond laser-assisted and conventional phacoemulsification.

BACKGROUND

The surgical safety of cataract patients with high myopia after pars plana vitrectomy (PPV) surgery deserves more attention. Currently, there are limited reported studies on the use of femtosecond laser-assisted cataract surgery (FLACS) to treat cataracts following PPV surgery in patients with high myopia. This study was designed to compare the clinical effects of FLACS and conventional phacoemulsification surgery (CPS) in these patients.

METHODS

A retrospective comparative cohort was conducted. The primary endpoint was best-corrected visual acuity (BCVA, logMAR) at 1 month after surgery. Confounding by indication was addressed using stabilized inverse probability of treatment weighting (IPTW) based on prespecified baseline covariates, with a doubly robust ANCOVA adjusting for baseline BCVA and clinical covariates. Longitudinal BCVA and intraocular pressure (IOP) were analyzed using linear mixed-effects models. Secondary endpoints were prespecified into families (Vision, IOP, Complication and adverse events). Per-time-point contrasts were descriptive and not multiplicity-adjusted; primary inference relied on Type III omnibus tests.

RESULTS

Seventy-seven eyes were included (FLACS, n = 33; CPS, n = 44). Post-weighting covariate balance was excellent (all standardized mean differences ≤ 0.07). The adjusted mean difference in Month-1 BCVA (FLACS - CPS) was - 0.17 logMAR (95% CI - 0.36 to 0.03), suggesting a possible benefit with uncertainty spanning negligible to moderate improvement. Early vision favored FLACS at Day-1 (- 0.29 logMAR; 95% CI - 0.53 to - 0.06) and the difference at Week-1 was small and imprecise (- 0.22 logMAR; 95% CI - 0.45 to 0.02); estimates converged by Month-1 to Month-3. IOP changed over time without an overall group difference; a small and imprecise higher IOP at Week-1, with estimates crossing zero. Nd: YAG capsulotomy rates were low and similar between groups.

CONCLUSIONS

In highly myopic post-PPV eyes, FLACS was associated with faster early visual recovery versus CPS, whereas 1-3 month outcomes were broadly similar. Findings are associative and may be influenced by residual confounding.