{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:36:29Z","timestamp":1785796589748,"version":"3.56.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Retin Vitr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the long-term incidence of recurrent vitreous hemorrhage(VH) and neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) alone versus combined PPV and phacoemulsification (PPV&amp;P).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This large, single-center, retrospective cohort study analyzed 548 eyes (137 PPV&amp;P, 411 PPV-alone) with a minimum 12-month follow-up. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression models were used to compare outcomes and identify independent predictors for complications within a 2-year follow-up period. A supplementary propensity score-matched (PSM) analysis was also performed to confirm the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the entire follow-up, the overall incidence of recurrence and NVG did not differ significantly between the groups. However, multivariable Cox regression analysis for the first two years revealed that PPV-alone was a significant protective factor against recurrence (adjusted Hazard Ratio [aHR], 0.61; 95% CI, 0.40\u20130.92), while severe preoperative traction was a major risk factor (aHR, 2.24; 95% CI, 1.39\u20133.60). For NVG development within two years, the surgical approach was not a significant factor. Instead, severe preoperative traction (aHR, 5.88; 95% CI, 1.67\u201320.68) and older age (aHR, 1.06; 95% CI, 1.01\u20131.11) were the primary independent risk factors.These findings were confirmed in a 1:1 age-matched PSM cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combined PPV with phacoemulsification is associated with an increased risk of recurrence within the first two postoperative years but does not increase the risk of neovascular glaucoma. The severity of baseline proliferative disease, particularly the degree of traction, is a more critical determinant of postoperative complications than the surgical strategy regarding the lens. This supports tailoring the surgical approach based on individual patient cataract status and retinal pathology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40942-025-00758-2","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T11:29:02Z","timestamp":1764329342000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Combined phacoemulsification and vitrectomy for proliferative diabetic retinopathy: an increased risk of early recurrence but not long-term neovascular glaucoma"],"prefix":"10.1186","volume":"11","author":[{"given":"Gengjia","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruibin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingwei","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiujie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"issue":"3","key":"758_CR1","doi-asserted-by":"publisher","first-page":"556","DOI":"10.2337\/dc11-1909","volume":"35","author":"JW Yau","year":"2012","unstructured":"Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, Chen SJ, Dekker JM, Fletcher A, Grauslund J, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556\u201364.","journal-title":"Diabetes Care"},{"key":"758_CR2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s40662-015-0026-2","volume":"2","author":"R Lee","year":"2015","unstructured":"Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015;2:17.","journal-title":"Eye Vis (Lond)"},{"issue":"8","key":"758_CR3","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3949\/ccjm.91a.24028","volume":"91","author":"DD Chong","year":"2024","unstructured":"Chong DD, Das N, Singh RP. Diabetic retinopathy: Screening, prevention, and treatment. Cleve Clin J Med. 2024;91(8):503\u201310.","journal-title":"Cleve Clin J Med"},{"issue":"11","key":"758_CR4","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","volume":"128","author":"ZL Teo","year":"2021","unstructured":"Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, Bikbov MM, Wang YX, Tang Y, Lu Y, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and Meta-analysis. Ophthalmology. 2021;128(11):1580\u201391.","journal-title":"Ophthalmology"},{"issue":"1","key":"758_CR5","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/aos.14482","volume":"99","author":"V Schreur","year":"2021","unstructured":"Schreur V, Brouwers J, Van Huet RAC, Smeets S, Phan M, Hoyng CB, de Jong EK, Klevering BJ. Long-term outcomes of vitrectomy for proliferative diabetic retinopathy. Acta Ophthalmol. 2021;99(1):83\u20139.","journal-title":"Acta Ophthalmol"},{"issue":"3","key":"758_CR6","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/ICU.0000000000000946","volume":"34","author":"S Pandit","year":"2023","unstructured":"Pandit S, Ho AC, Yonekawa Y. Recent advances in the management of proliferative diabetic retinopathy. Curr Opin Ophthalmol. 2023;34(3):232\u20136.","journal-title":"Curr Opin Ophthalmol"},{"issue":"9","key":"758_CR7","doi-asserted-by":"publisher","first-page":"e108933","DOI":"10.1371\/journal.pone.0108933","volume":"9","author":"Y Yang","year":"2014","unstructured":"Yang Y, Zhang J, Yan H. Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study. PLoS ONE. 2014;9(9):e108933.","journal-title":"PLoS ONE"},{"issue":"4","key":"758_CR8","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/S0161-6420(85)34015-0","volume":"92","author":"GW Blankenship","year":"1985","unstructured":"Blankenship GW, Machemer R. Long-term diabetic vitrectomy results. Report of 10 year follow-up. Ophthalmology. 1985;92(4):503\u20136.","journal-title":"Ophthalmology"},{"issue":"6","key":"758_CR9","doi-asserted-by":"publisher","first-page":"474","DOI":"10.3928\/15428877-20110901-02","volume":"42","author":"SD Schoenberger","year":"2011","unstructured":"Schoenberger SD, Miller DM, Riemann CD, Foster RE, Sisk RA, Hutchins RK, Petersen MR. Outcomes of 25-gauge Pars plana vitrectomy in the surgical management of proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging. 2011;42(6):474\u201380.","journal-title":"Ophthalmic Surg Lasers Imaging"},{"issue":"3","key":"758_CR10","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/01.icu.0000120676.27548.0e","volume":"15","author":"JM Lahey","year":"2004","unstructured":"Lahey JM, Francis RR, Kearney JJ, Cheung M. Combining phacoemulsification and vitrectomy in patients with proliferative diabetic retinopathy. Curr Opin Ophthalmol. 2004;15(3):192\u20136.","journal-title":"Curr Opin Ophthalmol"},{"issue":"1","key":"758_CR11","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1159\/000530231","volume":"66","author":"M Pei","year":"2023","unstructured":"Pei M, Zhao X, Wan G. A systematic review and Meta-Analysis of clinical outcomes of small gauge vitrectomy with or without intravitreal Anti-Vascular endothelial growth factor agents pretreatment for proliferative diabetic retinopathy. Ophthalmic Res. 2023;66(1):777\u201390.","journal-title":"Ophthalmic Res"},{"issue":"5","key":"758_CR12","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1007\/s13300-019-0672-9","volume":"10","author":"K Xiao","year":"2019","unstructured":"Xiao K, Dong YC, Xiao XG, Liang SZ, Wang J, Qian C, Wan GM. Effect of Pars plana vitrectomy with or without cataract surgery in patients with diabetes: A systematic review and Meta-Analysis. Diabetes Ther. 2019;10(5):1859\u201368.","journal-title":"Diabetes Ther"},{"issue":"10","key":"758_CR13","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.1097\/IAE.0000000000000171","volume":"34","author":"PS Silva","year":"2014","unstructured":"Silva PS, Diala PA, Hamam RN, Arrigg PG, Shah ST, Murtha TL, Schlossman DK, Cavallerano JD, Sun JK, Aiello LP. Visual outcomes from Pars plana vitrectomy versus combined Pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes. Retina. 2014;34(10):1960\u20138.","journal-title":"Retina"},{"key":"758_CR14","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.2147\/OPTH.S47780","volume":"7","author":"H Canan","year":"2013","unstructured":"Canan H, Sizmaz S, Altan-Yaycio\u011flu R. Surgical results of combined Pars plana vitrectomy and phacoemulsification for vitreous hemorrhage in PDR. Clin Ophthalmol. 2013;7:1597\u2013601.","journal-title":"Clin Ophthalmol"},{"issue":"1","key":"758_CR15","doi-asserted-by":"publisher","first-page":"22490","DOI":"10.1038\/s41598-024-73395-8","volume":"14","author":"S Hwang","year":"2024","unstructured":"Hwang S, Kim JH, Choi YH, Thng ZX, Hong EH, Kang MH, Shin YU. Incidence and risk factor analysis of neovascular glaucoma following vitrectomy in patients with proliferative diabetic retinopathy. Sci Rep. 2024;14(1):22490.","journal-title":"Sci Rep"},{"issue":"1","key":"758_CR16","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1038\/s41598-025-85667-y","volume":"15","author":"S Hwang","year":"2025","unstructured":"Hwang S, Hong EH, Kang MH, Shin YU. Early postoperative bevacizumab for preventing neovascular glaucoma in phacovitrectomy for proliferative diabetic retinopathy. Sci Rep. 2025;15(1):1231.","journal-title":"Sci Rep"},{"issue":"2","key":"758_CR17","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1159\/000098253","volume":"221","author":"P Kroll","year":"2007","unstructured":"Kroll P, Rodrigues EB, Hoerle S. Pathogenesis and classification of proliferative diabetic vitreoretinopathy. Ophthalmologica. 2007;221(2):78\u201394.","journal-title":"Ophthalmologica"},{"issue":"5","key":"758_CR18","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/0002-9394(85)90617-8","volume":"100","author":"LS Poliner","year":"1985","unstructured":"Poliner LS, Christianson DJ, Escoffery RF, Kolker AE, Gordon ME. Neovascular glaucoma after intracapsular and extracapsular cataract extraction in diabetic patients. Am J Ophthalmol. 1985;100(5):637\u201343.","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"758_CR19","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S0886-3350(87)80135-9","volume":"13","author":"T Pavese","year":"1987","unstructured":"Pavese T, Insler MS. Effects of extracapsular cataract extraction with posterior chamber lens implantation on the development of neovascular glaucoma in diabetics. J Cataract Refract Surg. 1987;13(2):197\u2013201.","journal-title":"J Cataract Refract Surg"},{"issue":"Pt 6","key":"758_CR20","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1038\/eye.1995.185","volume":"9","author":"SA Sadiq","year":"1995","unstructured":"Sadiq SA, Chatterjee A, Vernon SA. Progression of diabetic retinopathy and rubeotic glaucoma following cataract surgery. Eye (Lond). 1995;9(Pt 6):728\u201338.","journal-title":"Eye (Lond)"},{"issue":"11","key":"758_CR21","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1016\/S0886-3350(02)01354-8","volume":"28","author":"TY Chung","year":"2002","unstructured":"Chung TY, Chung H, Lee JH. Combined surgery and sequential surgery comprising phacoemulsification, Pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes. J Cataract Refract Surg. 2002;28(11):2001\u20135.","journal-title":"J Cataract Refract Surg"},{"issue":"5","key":"758_CR22","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/S0161-6420(83)34540-1","volume":"90","author":"AP Schachat","year":"1983","unstructured":"Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology. 1983;90(5):522\u201330.","journal-title":"Ophthalmology"},{"issue":"3","key":"758_CR23","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.ophtha.2006.08.017","volume":"114","author":"WM Schiff","year":"2007","unstructured":"Schiff WM, Barile GR, Hwang JC, Tseng JJ, Ceki\u00e7 O, Del Priore LV, Chang S. Diabetic vitrectomy: influence of lens status upon anatomic and visual outcomes. Ophthalmology. 2007;114(3):544\u201350.","journal-title":"Ophthalmology"},{"key":"758_CR24","doi-asserted-by":"publisher","first-page":"100756","DOI":"10.1016\/j.preteyeres.2019.03.002","volume":"72","author":"IM Nawaz","year":"2019","unstructured":"Nawaz IM, Rezzola S, Cancarini A, Russo A, Costagliola C, Semeraro F, Presta M. Human vitreous in proliferative diabetic retinopathy: characterization and translational implications. Prog Retin Eye Res. 2019;72:100756.","journal-title":"Prog Retin Eye Res"},{"issue":"12","key":"758_CR25","doi-asserted-by":"publisher","first-page":"2095","DOI":"10.1016\/j.ophtha.2005.07.010","volume":"112","author":"PT Yeh","year":"2005","unstructured":"Yeh PT, Yang CM, Yang CH, Huang JS. Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage: an ultrasound biomicroscopy study. Ophthalmology. 2005;112(12):2095\u2013102.","journal-title":"Ophthalmology"},{"issue":"7","key":"758_CR26","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/S1607-551X(09)70419-X","volume":"23","author":"HY Tseng","year":"2007","unstructured":"Tseng HY, Wu WC, Hsu SY. Comparison of vitrectomy alone and combined vitrectomy, phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy. Kaohsiung J Med Sci. 2007;23(7):339\u201343.","journal-title":"Kaohsiung J Med Sci"},{"key":"758_CR27","doi-asserted-by":"publisher","first-page":"1102361","DOI":"10.3389\/fendo.2023.1102361","volume":"14","author":"Y Tang","year":"2023","unstructured":"Tang Y, Shi Y, Fan Z. The mechanism and therapeutic strategies for neovascular glaucoma secondary to diabetic retinopathy. Front Endocrinol (Lausanne). 2023;14:1102361.","journal-title":"Front Endocrinol (Lausanne)"},{"key":"758_CR28","doi-asserted-by":"crossref","unstructured":"Mohite AA, Perais JA, McCullough P, Lois N. Retinal ischaemia in diabetic retinopathy: understanding and overcoming a therapeutic challenge. J Clin Med. 2023;12(6).","DOI":"10.3390\/jcm12062406"},{"issue":"5","key":"758_CR29","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.preteyeres.2007.06.001","volume":"26","author":"SS Hayreh","year":"2007","unstructured":"Hayreh SS. Neovascular glaucoma. Prog Retin Eye Res. 2007;26(5):470\u201385.","journal-title":"Prog Retin Eye Res"}],"container-title":["International Journal of Retina and Vitreous"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40942-025-00758-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40942-025-00758-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40942-025-00758-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T11:29:05Z","timestamp":1764329345000},"score":1,"resource":{"primary":{"URL":"https:\/\/journalretinavitreous.biomedcentral.com\/articles\/10.1186\/s40942-025-00758-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["758"],"URL":"https:\/\/doi.org\/10.1186\/s40942-025-00758-2","relation":{},"ISSN":["2056-9920"],"issn-type":[{"value":"2056-9920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"assertion":[{"value":"17 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"130"}}