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


METHODS
Retrospective, consecutive, interventional case series.


METHODS
Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between 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 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.


CONCLUSIONS
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.
Demetriades
Anna-Maria
AM
Wilmer Ophthalmological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-9353, USA.
Gottsch
John D
JD
Thomsen
Robert
R
Azab
Amr
A
Stark
Walter J
WJ
Campochiaro
Peter A
PA
de Juan
Eugene
E
Haller
Julia A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications*; D005128:Eye Diseases / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D012164:Retinal Diseases / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000473:pathology* / Q000601:surgery