Combined 23-Gauge Vitrectomy and Femtosecond Laser-Assisted Cataract Surgery

Abstract

Background: The aim of this study was to assess the safety and surgical results of femtosecond laser-assisted phacovitrectomy. Methods: A retrospective analysis of the medical records of patients over 50 years of age with vitreoretinal pathology, who had undergone pars plana vitrectomy using 23-gauge instruments and femtosecond laser-assisted cataract surgery and implantation of an intraocular lens, was performed at the Instituto de Microcirugía Ocular between June 2012 and September 2013. The diameter of the anterior capsulorhexis was set at 4.8 mm in cases where a gas tamponade was used and at 5 mm in all other cases. During the pars plana vitrectomy, posterior capsulotomy was performed on all eyes. An assessment was carried out of preoperative characteristics, surgical indications, postoperative results and complications. Only patients with a minimum of 3 months of follow-up were included. Results: A total of 21 eyes in 21 patients (71.4% women) were treated. Mean age (±SD) was 65.8 ± 6.4 years (range 53-76). The most common indication for surgery was epiretinal membrane (61.9%), followed by vitreous haemorrhage (23.8%) and macular hole (14.3%). The mean preoperative best corrected visual acuity (BCVA) was 0.81 ± 1.01 logMAR and the mean postoperative BCVA was 0.12 ± 0.19 logMAR (p = 0.003). 85.7% of patients improved their visual acuity. The remaining patients maintained their visual acuity. The only intraoperative complication related to femtosecond laser was 1 case of suction loss (4.8%). A patient with rhegmatogenous retinal detachment discovered during surgery required an additional circular scleral procedure and developed synechiaes in the early postoperative period (<1 month). There were no cases of subluxation of the intraocular lens. Mean follow-up was 6 months (range 3-14). Conclusions: The application of femtosecond laser in phacovitrectomy is a safe and effective technique that presents advantages compared to conventional techniques in cases of macular pathology and/or vitreous haemorrhage.

Combined Femtosecond Laser-Assisted Cataract Surgery and 27-Gauge Transconjunctival Sutureless Vitrectomy

“…FLACS was started in 2009 with incorporation into routine surgical practice occurring in 2010 [4,14]. e efficacy and safety of FLACS with 23gauge and 25-gauge vitrectomy have been published [5,15,16].…”

“…Gomez-Resa et al published a study including 21 eyes of 21 patients who underwent 23-gauge pars plana vitrectomy and femtosecond laser-assisted cataract surgery. e diameter of the capsulorhexis was chosen as 4.8 mm in eyes where the use of a gas tamponade was expected (e.g., macular hole) and 5 mm in all other eyes, and they reported that all the IOLs remained well positioned at 3 months follow-up [16].…”

“…e mean time of the phacoemulsification and intraocular lens implantation was 14.65 ± 0.93 (range, [13][14][15][16] minutes. e mean total surgical time was 50.31 ± 9.01 (range, 40-75) minutes.…”

Dynamic changes of optical aberrations during restoration of optical properties of hydrophobic acrylic intraocular lens ejected through cartridge

“…The recent technique using a femtosecond laser in cataract surgery requires the operating room to be kept at approximately 20°C with low humidity to maintain the performance of the femtosecond laser 18 19. The combination of femtosecond laser-assisted cataract surgery and vitrectomy has been reported to enhance the accuracy of the surgery 20 21.…”

Comment on: To assess survival outcomes of combined femtosecond laser-assisted cataract surgery with 25-gauge vitrectomy surgery at a tertiary eye care center

“…have used a scleral buckle in the single case that was found to have a retinal detachment intraoperatively in spite of doing 23-gauge vitrectomy with a femto cataract surgery. [4]…”