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      Intraocular Pressure Changes after Vitrectomy with and without Combined Phacoemulsification and Intraocular Lens Implantation

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          Abstract

          Purpose

          To determine sequential intraocular pressure (IOP) changes after pars plana vitrectomy (PPV) with or without combined phacoemulsification and intraocular lens implantation (PE & IOL).

          Methods

          Consecutive patients who underwent PPV with PE & IOL (combined group) or without PE & IOL (vitrectomy group) were reviewed for postoperative sequential IOPs and the number of IOP lowering medications used. Of the 68 patients (68 eyes) who underwent simple PPV, 41 eyes were allocated to the vitrectomy group, and 27 eyes to the combined group.

          Results

          The mean IOPs were higher on postoperative days one and two, as compared to preoperative values, in both groups. The mean IOP changes on postoperative day one (10.0 mmHg vs. 5.3 mmHg, p = 0.02) and day two (3.7 mmHg vs. 1.3 mmHg, p = 0.02) were significantly higher in the combined group.

          Conclusions

          Phacovitrectomy is associated with a higher risk of IOP elevation during the early postoperative period than PPV alone. Caution should be exercised in patients who are vulnerable to IOP fluctuations when combined surgery is indicated.

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          Most cited references26

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          Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker.

          We evaluated the occurrence or progression of nuclear sclerosis of the crystalline lens in 100 eyes after vitrectomy for removal of idiopathic epiretinal membranes causing macular pucker. The follow-up period ranged from six to 99 months (average, 29 months). Visually significant nuclear sclerosis was present preoperatively in three of the operated on eyes and four of the fellow eyes. The rate of occurrence or progression of visually significant nuclear sclerosis was far greater in the operated on eyes (P less than .0001). Of 100 patients, 80 operated on eyes and 24 fellow eyes had visually significant nuclear sclerosis or had undergone previous cataract extraction at the conclusion of the study. Different concentrations of glucose in the intraocular irrigating solution did not affect occurrence of later nuclear sclerosis. Patients older than 50 years of age had a far greater incidence of later nuclear sclerosis than patients younger than 50 years of age (P = .0003). Nuclear sclerosis may be caused by altered lens metabolism after removal of part of the vitreous gel, since nuclear sclerosis also occurs in other conditions associated with vitreous liquefaction.
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            Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology.

            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.
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              Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases.

              To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. Retrospective, consecutive, noncomparative, interventional case series. Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. Vision, number of secondary procedures, and complications. Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.
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                Author and article information

                Journal
                Korean J Ophthalmol
                KJO
                Korean Journal of Ophthalmology : KJO
                The Korean Ophthalmological Society
                1011-8942
                2092-9382
                December 2010
                23 November 2010
                : 24
                : 6
                : 341-346
                Affiliations
                [1 ]Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
                [2 ]Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
                [3 ]Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.
                Author notes
                Reprint requests to Kyu Hyung Park. Department of Ophthalmology, Seoul National University Bundang Hospital, #166 Gumi-dong, Bundang-gu, Seongnam 463-707, Korea. Tel: 82-31-787-7373, Fax: 82-31-787-4057, jiani4@ 123456snu.ac.kr
                Article
                10.3341/kjo.2010.24.6.341
                2992561
                21165232
                9b4ad6c6-17eb-4e8e-9c10-e01d406b7126
                © 2010 The Korean Ophthalmological Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 October 2010
                : 08 July 2010
                Categories
                Original Article

                Ophthalmology & Optometry
                phacoemulsification,pars plana vitrectomy,intraocular lens implantation,intraocular pressure

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