title: Phacovitrectomy for primary retinal detachment repair in presbyopes.
abstract: OBJECTIVE
  To review the results of phacovitrectomy for primary retinal detachment repair in presbyopes.
  
  
  METHODS
  The outcome and complications of surgery were examined in a retrospective case series of 93 presbyopic patients who underwent phacoemulsification and vitrectomy for primary rhegmatogenous retinal detachment.
  
  
  RESULTS
  Eighty-two patients (88.2%) had reattachment with a single procedure. The final reattachment rate with further procedures was 97.8%. Two patients (2.2%) in whom final reattachment did not occur declined further surgery after the primary repair. All redetachments were due to proliferative vitreoretinopathy. The median Snellen converted logMAR visual acuity improved from 1.00 preoperatively to 0.30 postoperatively (P < 0.001, Wilcoxon test). Postoperative complications included transient intraocular pressure rise (29%), fibrinous uveitis (16.2%), and iris/intraocular lens capture (8.6%). One of the eight patients with iris/intraocular lens capture required surgical reintervention. All cases of fibrinous uveitis and intraocular pressure rise resolved within a few days with medical treatment. Posterior capsular opacification occurred in 23 patients (24.7%).
  
  
  CONCLUSIONS
  Combined surgery with phacoemulsification, lens extraction, and vitrectomy offers significant advantages to both patient and surgeon in the management of primary retinal detachment. We believe that it should be considered for presbyopes even in the absence of significant lens opacity. Fibrinous uveitis and intraocular pressure rise may occur in a few patients in the immediate postoperative period but are transient and resolve with medical treatment. Further prospective studies are required, in particular to examine the rate of postoperative proliferative vitreoretinopathy, which may be higher than with vitrectomy alone.
authors.affiliation: West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.forename: S Vasant
authors.initials: SV
authors.lastname: Raman
authors.forename: George
authors.initials: G
authors.lastname: Pappas
authors.forename: Peter
authors.initials: P
authors.lastname: Simcock
authors.forename: Roland
authors.initials: R
authors.lastname: Ling
authors.forename: Steve
authors.initials: S
authors.lastname: Shaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D011305:Presbyopia / Q000150:complications*; D012163:Retinal Detachment / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy