VV 793Cataract surgery combined with vitreoretinal surgery
W. F. Schrader, P. Fischer
Background: New techniques in vitreoretinal surgery, as surgery of the macular hole or subretinal surgery, require an excellent visualisation of the posterior pole. Therefore, often cataract surgery is necessary before vitreoretinal surgery. We report on our experience with combined pars plana vitrectomy and phycoemulsification via corneosceral tunnel incision. This technique allows a watertight wound closure without visual impairment due to astigmatism caused by a suture.
Patients: We performed a pars plana vitrectomy combined with cataract surgery in 320 eyes between 1996 and 1999. The postoperative course was analyzed retrospectively.
Results: In 110 cases the combined procedure was performed in eyes with diabetic retinopathy, vitreous hemorrhage and/or tractional retinal detachment, in 40 eyes with subretinal neovascular membranes, in 31 eyes with macular holes, in 55 eyes with macular pucker and in 84 eyes with retinal detachment or in combination with silicone oil removal. A postoperative finbrinous reaction was seen significant more often in eyes with diabetic retinopathy (49%) and in eyes with proliferative vitreoretinopathy (61%) than in other diseases (2%). Inpatient treatment was shorter in all cases than it would have been with two separate procedures.
Conclusions: Cataract surgery using a small incision technique without suture can be safely combined with pars plana vitrectomy. This allows an improved visualization of the retina for the surgeon and shortens the postoperative course. If the blood retinal barrier is disturbed by proliferative diabetic retinopathy or proliferative vitreoretinopathy, the postoperative course may frequently be complicated by a fibrinous reaction. Because retroillumination is frequently not available due to the posterior segment pathology, the surgeon has to be very skilled in cataract surgery.
Universitätsaugenklinik, Josef-Schneider-Str. 11, D-97080 Würzburg