Phacovitrectomy

Abstract

Recent advances in vitreoretinal surgical technology combined with advances in small-incision cataract surgery have enabled the ophthalmic surgeon to provide combined management of cataract and retinal pathology. Progressive understanding of the inevitability of cataract progression after pars plana vitrectomy along with the negative impact of early cataract progression on visual acuity outcomes have defined the importance of combined cataract surgery and pars plana vitrectomy in improving surgical outcomes. Combining phacoemulsification with intraocular lens placement with vitrectomy has now been shown to decrease visual rehabilitation time in patients with early/visually significant cataracts. These benefits are especially apparent when complex ocular pathology is present and clear visualization during surgery is needed. This report focuses on specific factors pertaining to combined surgery that include patient selection, mechanics of phacovitrectomy, and potential complications. The authors report that utilization of combined phacovitrectomy at their institution has had an outstanding success rate with 95% of the patients achieving 2-line or greater improvements in visual acuity within 6 weeks of surgery. Combined phacovitrectomy is associated with a significant reduction in overall healthcare costs that may become more important in this era of healthcare reform. Finally, rapid adoption of combined phacovitrectomy has occurred internationally, but remains delayed at most institutions in the USA.

Clear Corneal Phacovitrectomy with Posterior Capsulorhexis and IOL Implantation in Management of Selective Vitreoretinal Cases

“…When we were on a “discovery curve” of CCPV, the operative time exceeded that of conventional phacovitrectomy; however, after a period of time, there is no significant difference in operative time. In comparison with the conventional separate performance of posterior and anterior segment surgeries, conventional combined phacovitrectomy reduces overall healthcare costs [ 22 , 23 ], time of both overall postoperative recovery course, and visual rehabilitation of patients [ 24 , 25 ]. Since the CCPV technique retains the basic features of conventional combined phacovitrectomy, it will share the above-mentioned advantages of the combined approach.…”

Clinical Aspects of Phacovitrectomy Complications

“…Кроме того, на глазах с наличием стекловидного тела факоэмульсификацию выполнять проще, поскольку после витрэктомии ядро хрусталика становится более плотным. Из-за отсутствия поддерж-ки со стороны стекловидного тела велика вероятность существенных колебаний глубины передней камеры, на-рушения поддержки со стороны задней капсулы, растя-жения и ослабления цинновых связок и нестабильности глубины передней камеры [4][5][6][7]. Как уже упоминалось выше, факовитрэктомия устраняет риск прогрессирова-ния катаракты (наиболее частого осложнения витрэкто-мии в отдаленном периоде), а также помутнений задней капсулы.…”

Comparison of 1.8‐mm incision versus 2.75‐mm incision cataract surgery in combined phacoemulsification and 23‐gauge vitrectomy

“…It has many advantages including fast visual acuity rehabilitation and clear visualization during vitrectomy (Steel ; Villegas et al. ). In addition, there is an ongoing trend to operate through smaller incisions in both vitreoretinal and cataract surgery (Fine et al.…”