Choice of Surgical Technique in the Management of Cataract Combined with Vitreous Surgery

Abstract

Purpose. To compare different methods of lens removal during vitreous surgery. Methods. We reviewed the data of 37 consecutive eye operations with combined surgery of the lens and vitreous in the Mülheim Eye Hospital between March ‘93 and September ‘94. Results. In 14 eyes a pars plana lensectomy was done, in 7 an ECCE (extra capsular cataract extraction), and in 16 phacoemulsification was combined with a regular threeport pars plana vitrectomy. Conclusions. The choice of procedure was mainly influenced by the hardness of the lens and whether an IOL implant was considered. If no IOL is planned and the lens is soft enough, the best way to remove it is by pars plana lensectomy. If the nucleus seems too hard, phacoemulsification should be performed, because of the risk of releasing the nucleus into the posterior segment. If an IOL is planned, the best method of lens removal is phacoemulsification via a scleral tunnel. In both cases if the nucleus is very hard ECCE should be performed because of the risk of corneal edema.

Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation

“…Even if the cataract is not significant, it may progress postoperatively due to both vitreoretinal surgery and intraocular tamponade. The presence of cataract will often necessitate a second operation soon after the vitreoretinal surgery if a lens extraction is not performed simultaneously with the vitreoretinal surgery 1,2 . Because of the lack of vitreous support and loss of integrity of the zonules after the vitrectomy, in some cases cataract surgery was made difficult by unusual fluctuations in the anterior chamber depth and lens zonule instability 3…”