Macular Hole Surgery and Cataract Extraction: Combined vs Consecutive Surgery

Muselier, A.; Dugas, B.; Burelle, X.; Passemard, M.; Hubert, I.; Mathieu, B.; Berrod, J.–P.; Bron, Alain M.; Creuzot‐Garcher, Catherine

doi:10.1016/j.ajo.2010.04.008

Cited by 73 publications

(45 citation statements)

References 31 publications

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“…10 The incidence of breaks did not appear to be higher in patients undergoing combined phacovitrectomy compared with vitrectomy alone, a finding supported by similar studies in the literature. 11,12 Breaks were observed more commonly in phakic compared with pseudophakic patients. This has been shown to be a factor in other studies.…”

Section: Discussionmentioning

confidence: 93%

“…8 It has been observed that new breaks are more common in patients requiring surgical induction of PVD than in those with pre-existing PVD. 11 This could offer an explanation for the higher rate of breaks in phakic patients compared with pseudophakic patients who might be more likely to have already developed PVD following cataract surgery. 13 Our study did not compare the incidence of PVD pre-operatively in both the groups.…”

Section: Discussionmentioning

confidence: 99%

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The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

Gosse

Newsom

Lochhead

2011

Eye

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Purpose The development of 23-gauge vitrectomy surgery has many benefits including a reduction in surgical time and faster postoperative rehabilitation; however, some have suggested that the complication rate is higher. To assess this we compared the incidence and distribution of iatrogenic retinal tears in 20-and 23-gauge surgery. Methods Fifty consecutive 23-gauge and 50 consecutive 20-gauge vitrectomy cases were selected; eyes with a history of previous vitreoretinal surgery were excluded. All surgery was performed by two surgeons (JL and RN). Entry-site breaks (ESB) were defined as any new vitreoretinal abnormality occurring within 1 clock hour of an entry site for which treatment with cryotherapy was deemed necessary. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher's exact and v 2 -tests. Results ESB occurred in 24% (12/50) of cases in the 20-gauge group compared with 8% (4/50) in the 23-gauge group (P ¼ 0.03); 88% (14/16) occurred superiorly on the same side as the surgeons' dominant hand. Iatrogenic breaks recorded elsewhere indicated an increased incidence in the 20-gauge group (9/50 compared with 6/50 in 23-gauge) but this did not achieve significance; the most common position was at 6 o'clock. Conclusions 23-Gauge vitrectomy is associated with significantly fewer ESB when compared with conventional 20-gauge vitrectomy. The incidence of other iatrogenic breaks did not appear to be significantly different between the two groups.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

Gosse

Newsom

Lochhead

2011

Eye

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“…The anatomical closure rates compare very favourably with those of other published series looking at PVT and intravitreal gas tamponade with closure rates of 89-100% 5, 12-14 and vitrectomy alone with intravitreal gas tamponade demonstrating a closure rate of 96%. 14,15 The incidence of inducing iatrogenic retinal breaks in 20-gauge vitrectomy for macular hole (without ILM peeling) has been reported as 3.2% with a hole closure 15,18 Macular hole surgery is associated with a higher incidence of causing iatrogenic retinal breaks than vitrectomy surgery for other vitreoretinal pathology, 19,20 presumed to be due to the surgical induction of a posterior vitreous detachment. Induction of the posterior vitreous detachment can cause a tractional retinal break usually near the vitreous base inferiorly.…”

Section: Discussionmentioning

confidence: 99%

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Krishnan

Tossounis

Yang

2012

Eye

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Purpose To assess and compare the complications and long-term visual and anatomical outcomes of 20-and 23-gauge phacovitrectomy (PVT) for idiopathic macular hole repair. Methods A retrospective, consecutive, interventional case series of 72 eyes with idiopathic macular holes were managed with 20-gauge PVT (n ¼ 36) or 23-gauge PVT (n ¼ 36). All patients underwent a posteriorchamber intra-ocular lens implantation and internal-limiting-membrane peel with the aid of either trypan blue or brilliant blue G 250 dyes. Results The macular hole closure rate was 97% with 20-gauge PVT and 100% with 23-gauge PVT. Mean follow-up was 24.06 ( ± 12.83) months with 20-gauge PVT and 17.47 ( ± 5.79) with 23-gauge PVT. Mean visual acuity improvement in LogMar was 0.41 ( ± 0.32) with 20-gauge PVT and 0.52 (±0.25) with 23-gauge PVT (P ¼ 0.135). The incidence of retinal breaks was higher with the 20-gauge PVT compared with the 23-gauge PVT, occurring in 13 (36.1%) and 4 (11.1%) cases, respectively (P ¼ 0.025). There were no cases of retinal detachment. Postoperative intraocular pressure (IOP), at day 1, was significantly higher with 20-gauge PVT at 24.77 (±12.68) mm Hg compared with 17.20 (±6.95) mm Hg in 23-gauge PVT (P ¼ 0.0028). Operating times were longer in 20-gauge PVT at 89.36 ( ± 15.26) min compared with the 23-gauge PVT at 79.33 ( ± 23.82) min (P ¼ 0.04). Conclusion The 20-gauge PVT compared with 23-gauge PVT for macular hole repair is a slightly longer procedure and was associated with an increased incidence of retinal breaks and short-term elevated IOP. Both techniques have comparable visual and anatomical outcomes, but the 23-gauge PVT has advantages with regard to safety profile and operating time.

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“…Regardless of the lens status, phacovitrectomy may be preferred to vi- trectomy alone in order to pre-empt the progression of post-vitrectomy cataract and provide quicker overall visual recovery [2].…”

Section: Introductionmentioning

confidence: 99%

Refractive Outcomes Using the Lenstar Optical Low Coherence Reflectometry Biometer in Phacovitrectomy for Epiretrinal Membranes and Macular Holes

Fajgenbaum¹,

Robins²,

Williamson³

2017

OJOph

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Objective: To compare refractive outcomes using the Lenstar optical low-coherence reflectometry (OLCR) biometer in the following cases: phacovitrectomy for epiretinal membranes and macular holes (phacovitrectomy group); sequential cataract surgery after prior vitrectomy (sequential-phaco group); routine cataract surgery (phaco-only group). Methods: This study was a retrospective, consecutive comparative series. Main outcomes were mean prediction error (ME) and mean absolute prediction error (MAE). Secondary outcome was the variance in prediction error. Results: ME was significantly more myopic in the phacovitrectomy group (−0.08 ± 0.77D, mean ± SD, p = 0.04) and the sequential-phaco group (−0.09 ± 0.51D, p = 0.01) compared to the phaco-only group (+0.24 ± 0.53D). MAEs were not statistically different across the 3 groups. The phacovitrectomy group had a wider variance in prediction errors compared to the phaco-only group (p = 0.03). Conclusions: There is a myopic shift of approximately −0.3D in both phacovitrectomy and sequential-phaco cases compared to phaco-only cases when using OLCR-based optical biometry. Phacovitrectomy outcomes are more variable compared to phaco-only eyes.

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Macular Hole Surgery and Cataract Extraction: Combined vs Consecutive Surgery

Cited by 73 publications

References 31 publications

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Refractive Outcomes Using the Lenstar Optical Low Coherence Reflectometry Biometer in Phacovitrectomy for Epiretrinal Membranes and Macular Holes

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