Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach.
OBJECTIVE
To report intra-and postoperative complications in pars plana vitrectomy, phacoemulsification and intraocular lens implantation. A comparison of the combined versus two step surgical approach is given.


METHODS
Medical records and operative notes of 111 eyes with combined surgery and 50 eyes with sequential surgery were retrospectively analysed. Subgroup analysis was performed to evaluate differences in disease groups, the use of endotamponading or endolaser and cryocoagulation. Postoperative follow-up time was between 3 and 18 months.


RESULTS
Combined surgery: 64 eyes (57.5%) showed no complications. 17 eyes (15.3%) showed transient intraocular pressure rise, 17 eyes (15.3%) fibrinous exudation in the anterior chamber. Posterior capsule tears occurred in 7 eyes (6,3%), formation of posterior synechia was observed in 7 eyes (6.3%). IOL dislocation was seen in 3 eyes (2.7%), heavy covering of macrophages in 3 eyes (2,7%). Rare complications included silicon oil efflux into the anterior chamber (1.8%), anterior chamber hemorrhage (1,8%) and iris incarceration into the corneoscleral incision (0,9%). One eye needed explantation of the IOL during the follow-up. Sequential surgery: 31 eyes (62%) showed no complication. Transient intraocular pressure rise occurred in 14 eyes (28%), fibrinous exudation in 2 eyes (4%). Formation of posterior synechia was observed in 1 eye (2%), posterior capsule tears occurred in 4 eyes (8%). Dislocation of the IOL was seen in 1 eye (2%). Subgroup analysis revealed fibrinous exudation in the anterior chamber to be significantly more frequent after combined surgery, particularly in cases of proliferative diabetic retinopathy.


CONCLUSIONS
Combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation as well as the two-step procedure are safe and effective. Sequential surgery could be advantageous to minimize the postoperative anterior chamber inflammatory response.
Treumer
Felix
F
Department of Ophthalmology, University of Schleswig-Holstein, Campus Kiel, Hegewischstr. 2, 24105 Kiel, Germany. f.treumer@gmx.net
Bunse
Arnd
A
Rudolf
Martin
M
Roider
Johann
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications / Q000628:therapy; D005128:Eye Diseases / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D012164:Retinal Diseases / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000473:pathology