To report the preoperative, intraoperative, and postoperative outcomes of combining
phacoemulsification and posterior chamber intraocular lens (IOL) implantation with
pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal
pathology.
Retrospective, consecutive, interventional case series.
Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute
between March 1995 and May 2000 were reviewed.
In all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89
years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy
previously. Macular pathology (hole, membrane, choridal neovascularization) was present
in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage,
macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification
and IOL implantation were performed before vitreoretinal surgery. Preoperative vision
ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to
no light perception. In 105 patients vision improved, in 7 there was no change, and
in 10 vision decreased. Postoperative complications included opacification of the
posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous
hemorrhage, retinal detachment and iris capture by the IOL.
Combined surgery is a reasonable alternative in selected patients. Techniques that
may simplify surgery and reduce complications include: careful, limited, curvilinear
capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing
of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting
dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.
Copyright 2003 by Elsevier Science Inc.