Outcomes and Safety of Femtosecond Laser-Assisted Phacovitrectomy Using 25-Gauge Pars Plana Vitrectomy

Abstract

Objectives: To evaluate the safety, visual outcomes, and complication profile of femtosecond laser-assisted cataract surgery (FLACS) combined with 25-gauge pars plana vitrectomy (PPV) in patients with concurrent cataract and vitreoretinal disease. Methods: This retrospective study included 57 eyes of 57 patients who underwent FLACS with a standardized 4.8-mm capsulotomy followed by 25-gauge PPV at a tertiary referral center in Istanbul, Türkiye, between August 2020 and May 2025. Data collected included intraoperative events, postoperative best-corrected visual acuity (BCVA, Snellen converted to logMAR for analysis), intraocular pressure (IOP), and complication rates over a mean follow-up of 15.8±1.8 months. Results: Mean BCVA significantly improved from 0.68±0.34 logMAR preoperatively to 0.28±0.14 logMAR at 1 month, 0.19±0.11 logMAR at 3 months, and 0.15±0.14 logMAR at the final visit (all p<0.001). All eyes achieved meaningful visual recovery with stable and well-centered intraocular lenses and attached retinas. On postoperative day 1, post-hoc pairwise analysis revealed a significantly lower IOP in the air tamponade group compared with the SF6 and BSS groups (MD=−4.24, p<0.001); no significant IOP differences were found between groups at week 1, month 1, or month 3. Intraoperative complications included loss of cone suction (n=2, 3.5%) and incomplete capsulorhexis (n=2, 3.5%). Miosis occurred in 6 eyes (10.5%), and sclerotomy leakage requiring suturing in 7 eyes (12.3%). Conclusion: Combined FLACS and 25-gauge PPV is a safe and effective option for the management of coexisting cataract and vitreoretinal pathologies. The procedure provides favorable anatomical and visual outcomes with a low incidence of intraoperative and postoperative complications, supporting its use in appropriately selected patients. Prospective controlled studies are warranted to confirm these findings.