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Combined phaco-vitrectomy considerations vary with circumstance
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KOLOA, Hawaii — Overall, the majority of patients with cataract who undergo vitrectomy have progression of their cataract postoperatively, so it is reasonable for patients with significant cataract to undergo both procedures at the same time, Rajendra S. Apte, MD, PhD, said at Retina 2017.
“It would definitely be more convenient for the patient,” Apte said.
Rajendro Apte
There are many things to think about in patients who need vitrectomy and cataract surgery and whether to perform the operations singly or simultaneously.
In favor of the dual procedure is the potential for a more complete peripheral vitrectomy in a phakic eye, he said.
Another factor to consider that would favor the dual procedure is the need to avoid multiple surgeries in patients with comorbidities, such as diabetes, who are “medically relatively unstable,” he said.
From the cataract surgeon’s perspective, “Most cataract surgeons don’t like operating in post-vitrectomy eyes,” Apte said. They have concerns about weak zonules, unstable posterior capsules and potential defects in the posterior capsule.
Reasons to consider that could sway against the decision, particularly for anterior segment surgeons, is that the cataract may be borderline rather than significant, vitreous hemorrhage could cause a poor red reflex, making cataract surgery more difficult, and presence of a retinal detachment and hypotony could make management of the bag more difficult, he said.
“Most cataract surgery now is sutureless,” Apte said. “If you’re doing the combined procedure, then you may need to temporarily suture the corneal wound.” – by Patricia Nale, ELS
Reference:
Apte RS. Principles of combined phaco-vitrectomy. Presented at: Retina 2017; Jan. 16-20, 2017; Koloa, Hawaii.
Disclosure: Apte reports no relevant financial disclosures.