Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology

. PURPOSE: To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular tens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. . DESIGN: Retrospective, consecutive, interventional case series. . METHODS: Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute be tween March 1995 and May 2000 were reviewed. . RESULTS: 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 under. gone 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, phaco-emulsification 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. . CONCLUSIONS: Combined surgery is a reasonable al ternative in selected patients. Techniques that may sim plify 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. (C) 2003 by Elsevier Science Inc. All rights reserved.