Combined phacoemulification, intraocular len implantation, and vitrectomy for eye with coexiting cataract and vitreoretinal pathology

Purpoe To report the preoperative, intraoperative, and potoperative outcome of combining phacoemulification and poterior chamber intraocular len (IOL) implantation with par plana vitrectomy in eye with ignificant cataract and coexiting vitreoretinal pathology. Deign Retropective, conecutive, interventional cae erie. Method Chart of patient undergoing combined procedure at the Wilmer Ophthalmologic Intitute between March 1995 and May 2000 were reviewed. Reult In all, 122 eye of 111 patient were identified. Patient age ranged from 27 to 89 year (mean 65). Forty-three eye had diabetic retinopathy; 11 had undergone vitrectomy previouly. Macular pathology (hole, membrane, choridal neovacularization) wa preent in 69 eye. The mot common indication for urgery were diabetic vitreou hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cae, phacoemulification and IOL implantation were performed before vitreoretinal urgery. Preoperative viion ranged from 20/30 to light perception and potoperative viion ranged from 20/20 to no light perception. In 105 patient viion improved, in 7 there wa no change, and in 10 viion decreaed. Potoperative complication included opacification of the poterior capule, increaed intraocular preure, corneal epithelial defect, vitreou hemorrhage, retinal detachment and iri capture by the IOL. Concluion Combined urgery i a reaonable alternative in elected patient. Technique that may implify urgery and reduce complication include: careful, limited, curvilinear capulorhexi; in-the-bag placement of IOL; ue of IOL with larger optic; uturing of cataract wound before vitrectomy; ue of miotic and avoidance of long-acting dilating drop in patient with intravitreal ga; and ue of wide-field viewing ytem.