Refractive changes after vitrectomy and phacovitrectomy for macular hole and epiretinal membrane

Several studies have described changes in refraction toward myopia in eyes having vitrectomy and phacovitrectomy. This article reviews studies of the refractive outcome in phakic and pseudophakic eyes after vitrectomy and phacovitrectomy for macular hole or epiretinal membrane. Several factors play a role in refraction, including measurement of the axial length, changes in the effective lens position and the anterior chamber depth, the use of intraocular gas tamponade, the formula for intraocular lens (IOL) power calculation, and the IOL type. Most phakic eyes with macular hole or epiretinal membrane that have vitrectomy will develop cataract. Therefore, the sequence of surgery has to be considered; ie (1) performing combined phacovitrectomy, (2) vitrectomy and subsequent cataract surgery, or (3) cataract surgery and subsequent vitrectomy. Most studies reviewed in this article found a myopic shift regardless of the sequence of the surgery.