Posterior synechia formation after phacovitrectomy – Predicting factors and the role of short‐acting mydriatics

Purpose To evaluate the influence of topical short‐acting mydriatics on the formation of posterior synechia after phacovitrectomy surgery of pars plana vitrectomy and phacoemulsification with intraocular lens implantation. Methods A prospective randomised controlled trial. Fifty‐seven adult (>18 years old) patients (57 eyes) who underwent phacovitrectomy surgery at a single tertiary hospital, were randomly divided into two groups. The control group (29 eyes) received standard postoperative treatment (topical antibiotics and steroids). The study group (28 eyes) received short‐acting mydriatics together with standard therapy. Patients were followed until 24 months after surgery. The primary outcome measure was the formation of posterior synechia during the follow‐up period. Results A total of 7 patients developed posterior synechia during the follow‐up period (12%), 3 in the study group (11%) and 4 in the control group (14%). There was no statistical difference between the groups. Significant associations for the development of posterior synechia were surgery for retinal detachment, longer surgery duration (>93 min) and the use of tamponade, in particular silicone oil. Conclusions The use of topical short‐acting mydriatic drops after phacovitrectomy surgery, in addition to standard post‐operative treatment, did not reduce the formation of posterior synechia. However, we identified several factors that may influence or act as predictors for the development of posterior synechia: surgery for retinal detachment, using silicone oil tamponade and a longer surgery duration. Our findings may aid in the standardisation of post‐phacovitrectomy surgery treatment and define potential at‐risk patients who should be monitored more closely.