| Sumario: | 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. Design: Retrospective single-center observational study. 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. Plain language summary: Combined phacovitrectomy for retinal detachment and cataract - macular attachment and visual fixation as predictors of postoperative refractive error Combined phacovitrectomy is a widely used procedure for retinal detachment, avoiding the need for additional surgeries and associated complications. However, macular involvement with central fixation loss alters biometric data for IOL power calculation. This study highlights that refractive outcomes may be significantly worse in such cases, with postoperative errors potentially explained by chord alpha, a measure of central fixation. These findings suggest that while the advantages of combined phacovitrectomy are compelling, future research should evaluate its suitability for patients with macular detachment, given the risk of refractive errors exceeding 1 diopter.
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