Abstract
Purpose and methods Cataract extraction may be combined with vitrectomy to improve the operative view and/or enhance post-operative rehabilitation. A retrospective review of the records of all patients undergoing combined phacoemulsification and vitrectomy procedures since 1993 was performed. Surgical technique is discussed.
Results Fifty operations on 49 patients are described. Visual acuity improved overall (mean LogMAR acuity 1.58 ± 0.74 pre-operatively and 1.17 ± 0.76 LogMAR post-operatively), with 57% of patients having improved acuity post-operatively. Operative complications were few and post-operative complications were acceptable given the severity of the posterior segment disease.
Conclusions Combined phacoemulsification-vitrectomy surgery is a viable option in the management of posterior segment disease in the presence of cataract. It has a number of advantages over other approaches, and can be combined with intraocular lens insertion into the capsular bag in most cases.
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Senn P, Schipper I, Perren B . Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure. Ophthalmic Surg Lasers 1995;26:420–8.
Ryan EH, Gilbert HD . Lensectomy, vitrectomy indications and techniques in cataract surgery. Curr Opin Ophthalmol 1996;7:69–74.
Lam DSC, Tham CCY, Kwok AKH, Gopal L . Combined phacoemulsification, pars plana vitrectomy, removal of intraocular foreign body (IOFB), and primary intraocular lens implantation for patients with IOFB and traumatic cataract. Eye 1998;12:395–8.
Mamalis N, Teske MP, Kreisler KR, Zimmerman PL, Crandall AS, Olsen RJ . Phacoemulsification combined with pars plana vitrectomy. Ophthalmic Surg 1991;22:194–8.
Koenig SB, Mieler WM, Han DP, Abrams GW . Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion. Arch Ophthalmol 1992;110:1101–4.
Bailey IL, Lovie JE . New design principles for visual acuity letter charts. Am J Optom Physiol Optics 1976;53:740–5.
Moseley JM . Graphical representation of visual acuity data. Ophthalmic Physiol Opt 1997;17:441–2.
Javitt JC, Brenner MH, Curbow B, Legro MW, Street DA . Outcomes of cataract surgery: improvements in visual acuity and subjective visual function after surgery in the first, second and both eyes. Arch Ophthalmol 1993;111:686–91.
McElvanney AM, Talbot EM . Posterior chamber lens implantation combined with pars plana vitrectomy. J Cataract Refract Surg 1997;23:106–9.
Hurley C, Barry P . Combined endocapsular phacoemulsification, pars plana vitrectomy, and intraocular lens implantation. J Cataract Refract Surg 1996;22:462–6.
Honjo M, Ogura Y . Surgical results of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation for complications of proliferative diabetic retinopathy. Ophthalmic Surg Lasers 1998;29:99–105.
Apple DJ, Federman JL, Krolicki TJ, Sims JCR, Kent DG, Hamburger HA, et al. Irreversible silicone oil adhesion to silicone intraocular lenses: a clinicopathologic analysis. Ophthalmology 1996;103:1555–62.
Minckler D, Astorino A, Hamilton P . Cataract surgery in diabetics. Ophthalmology 1988;105:949–50.
Wagner T, Knaflic D, Rauber M, Mester U . Influence of cataract surgery on the diabetic eye: a prospective study. Ger J Ophthalmol 1996;103:1555–61.
Benson WE, Brown GC, Tasman W, McNamara JA . Extracapsular cataract extraction, posterior chamber lens insertion, and pars plana vitrectomy in one operation. Ophthalmology 1990;97:918–21.
Kokame GT, Flynn HW, Blankenship GW . Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy. Ophthalmology 1989;96:603–10.
Menchini U, Azzolini C, Camesasca FI, Brancato R . Combined vitrectomy, cataract extraction, and posterior chamber intraocular lens implantation in diabetic patients. Ophthalmic Surg 1992;22:69–73.
Rice TA, Michels RG, Maguire MG, Rice EF . The effect of lensectomy on the incidence of iris neovascularisation and neovascular glaucoma after vitrectomy for diabetic retinopathy. Am J Ophthalmol 1983;95:1–11.
Fastenberg DM, Schwartz PL, Shakin JL, Golub BM . Management of dislocated nuclear fragments after phacoemulsification. Am J Ophthalmol 1991;112:535–9.
Borne MJ, Tasman W, et al. Outcomes of vitrectomy for retained lens fragments. Ophthalmology 1996;103:971–6.
Michelson JB, Friedlander MH, Nozik RA . Lens implant surgery in pars planitis. Ophthalmology 1990;97:1023–6.
Foster RE, Lowder CY, Meisler DM, Zakov N . Extracapsular cataract extraction and posterior chamber intraocular lens implantation in uveitis patients. Ophthalmology 1992;99:1234–41.
Vasavada A, Singh R, Desai J . Phacoemulsification of white mature cataracts. J Cataract Refract Surg 1998;24:270–7.
Tasman W . Are there any retinal contraindications to cataract extraction and posterior chamber implants? Arch Ophthalmol 1986;104:1767–8.
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Leyland, M., Schulenburg, W. Combined phacoemulsification-vitrectomy surgery: Technique, indications and outcomes. Eye 13, 348–352 (1999). https://doi.org/10.1038/eye.1999.88
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DOI: https://doi.org/10.1038/eye.1999.88