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Combine phaco with pars plana vitrectomy for complex rhegmatogenous retinal detachment, surgeon says
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CHICAGO — Phacoemulsification surgery at the time of macular hole or retinal detachment repair may be warranted in some patients, as studies suggest a high rate of cataract development in the months following vitrectomy, according to a speaker here.
"It is thought that cataract results from increased levels of oxygen presented to the lens during vitrectomy producing oxidative stress," Faisal Fayyad, MD, said during a symposium on complex retinal detachment management co-sponsored by the American Academy of Ophthalmology and the Middle East Africa Council of Ophthalmology.
Presence of cataract at the time of surgery is an indication for dual surgery, but other scenarios may also suggest the utility of combined surgery: high myopia, a lens touch during surgery, anterior proliferative vitreoretinopathy and potentially the presence of large retinal tears, Dr. Fayyad said.
The combined approach offers the obvious advantage of a single surgery, but also may help visualization during delicate maneuvers at the back of the eye, maintains separation of the anterior and posterior segments, allows the surgeon to perform vitreous base shaving without fear of damaging the lens and may lead to earlier visual rehabilitation.
However, Dr. Fayyad noted, surgeons performing dual phaco and vitrectomy should monitor for fibrinous uveitis and elevated IOP postoperatively, and should be aware of potential problems with IOL power calculations.