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Smaller instruments produce less astigmatism in combined phacovitrectomy

Graefes Arch Clin Exp Ophthalmol. 2009;247(10):1331-1337

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Combined phacoemulsification and vitrectomy may induce astigmatic changes on the ocular surface in the immediate postoperative period, but smaller instrumentation may be beneficial.

In a prospective study of 40 eyes in 37 consecutive patients, 20 eyes of 19 patients underwent the combined procedure with 23-gauge transconjunctival sutureless vitrectomy and 20 eyes of 18 patients underwent the combined procedure with 20-gauge standard vitrectomy.

In all patients, surgery induced astigmatic change in the immediate postoperative period. However, surgically induced astigmatism decreased in all patients at weeks 4, 8 and 12 postoperatively.

There was a significant difference in surgically induced astigmatism between the two groups: 1.07 D in the 23-gauge group compared with 2.09 D in the 20-gauge group at week 1 postoperatively. As well, patients who underwent gas tamponade in the 23-gauge group had significantly greater surgically induced astigmatism than patients who underwent non-gas tamponade.