A Review of Microinvasive Combined Phaco-Vitrectomy: Recent Technical Advances

Abstract

Combined cataract and vitreoretinal surgery results in better compliance in patients with posterior segment pathology and should be the preferred approach to reduce the high rate of cataract development after vitreoretinal surgery and to improve earlier visual acuity. Technological advances in both anterior and posterior segment surgery are leading to the development of instruments with a smaller diameter and more efficient tools, resulting in a minimizing of the tissue trauma related to the surgery, acceleration of functional recovery and increasing patient comfort. In this review we report on recent advances that allow this miniaturization process while maintaining the efficacy and safety of microinvasive combined surgical procedures, with a focus on pumps, illumination, phaco tip and the vitrectomy probe.

Clinical outcome of 23g Trans-Conjunctival pars plana vitrectomy: A prospective comparison of Phaco-Vitrectomy with only vitrectomy in phakic eyes

“…With the recent advances in small gauge cataract surgery, the threshold of combining phacoemulsification with other intra and extra ocular surgeries has come down. 1 With this growing ease in handling complex surgeries, many vitreoretinal surgeons are preferring to perform pars plana vitrectomy (PPV) with phacoemulsification in a single sitting. 2 Although merits and demerits of combined procedures will be discussed here, it is not always the surgeons choice to perform both procedures together.…”

Clinical Outcomes of Combined Phacoemulsification With Intraocular Lens Placement and Microincision Vitrectomy in Adult Vitreoretinal Disease

“…6,12,27 However, the advent of small-gauge vitrectomy instruments has improved safety outcomes and expanded the variety of indications for vitreoretinal surgery. 2,4,6 Over the years, combined MIVS and cataract surgery has gained increasing acceptance because it avoids the need for a second surgical procedure for cataract extraction, maximizes visualization of the retina, allows for better access to the vitreous base, promotes rapid visual rehabilitation, and reduces patient discomfort, the number of total surgical procedures, and surgical costs. 2,5,7,11,12,15,17,18,23,24 Furthermore, recent studies have shown that combined surgery is a safe and effective procedure for the management of vitreoretinal diseases.…”

“…6,12,27 However, the advent of small-gauge vitrectomy instruments has improved safety outcomes and expanded the variety of indications for vitreoretinal surgery. 2,4,6…”

“…Vitrectomy surgery has shifted from historical 20-gauge surgery to microincision vitrectomy surgery (MIVS) with the use of smaller 23-, 25-, and 27-gauge instruments. [1][2][3][4] Over the years, MIVS has evolved as the standard surgical procedure for the management of vitreoretinal diseases. The advantages of MIVS include reduced surgical time, faster recovery of visual acuity (VA), less postoperative inflammation and patient discomfort, low rates of intraoperative and postoperative complications, and expanding indications for surgery.…”