Microincision Cataract Surgery Combined With Vitrectomy
Microincision Cataract Surgery Combined With Vitrectomy
The authors present a single-centre, retrospective, consecutive case series. The medical records including electronic vitreoretinal surgical operation database of 52 cases of combined cataract surgery and vitrectomy operated from October 2011 to March 2012 were reviewed.
Preoperative data included patient's age, sex, best-corrected visual acuity, previous ocular history and indication for vitrectomy. Intraoperative data included corneal wound suturing if required, the type of IOL used and any complications.
Postoperative data included visual acuity, degree of anterior chamber inflammation, and intraocular pressure (IOP) measured by Goldman applanation tonometry. Anterior segment complications such as wound leak, IOL decentration and posterior capsule opacification, and posterior segment complications such as endophthalmitis and retinal detachment were noted. Significant inflammation was defined as inflammation needing an increase in topical steroids above the usual postoperative regimen.
Cataract surgery was performed before vitrectomy, using a microincision technique, with a 1.8 mm clear corneal incision. The IOL was inserted without enlarging the wound using a wound-assisted technique, where the cartridge tip of the lens injector projected firmly into the wound without entering the anterior chamber. Akreos AO MI-60 Micro Incision Lens (Bausch and Lomb, Rochester, NY, USA) was used in all cases except where there was a posterior capsular rupture, where a larger MA60 lens (Alcon Laboratories Inc., Fort Worth, TX, USA) was implanted in the sulcus. If the anterior chamber was formed and stable at the end of cataract surgery, the main corneal wound was not sutured, and the surgeons proceeded to the vitrectomy using the Stellaris PC Vitrectomy System (Bausch and Lomb). The vitrectomies carried out in the department had a standard approach comprising core vitrectomy and peripheral shave anterior to the equator without indentation except for retinal detachments, where a complete peripheral shave with indentation was carried out. All cases underwent an internal search to identify iatrogenic anterior retinal tears and sclerotomy-associated retinal tears towards the end of the procedure, and if present these were treated accordingly.
Patients were given prednisolone acetate 1% eye drops 2 hourly for 1 week and four times for 3 more weeks, and topical antibiotics and cycloplegics for 2 weeks.
All cases were routinely seen on day 1, 2 weeks, 6–8 weeks, and then 3 months postoperatively with variations at surgeon's discretion.
Materials and Methods
The authors present a single-centre, retrospective, consecutive case series. The medical records including electronic vitreoretinal surgical operation database of 52 cases of combined cataract surgery and vitrectomy operated from October 2011 to March 2012 were reviewed.
Preoperative data included patient's age, sex, best-corrected visual acuity, previous ocular history and indication for vitrectomy. Intraoperative data included corneal wound suturing if required, the type of IOL used and any complications.
Postoperative data included visual acuity, degree of anterior chamber inflammation, and intraocular pressure (IOP) measured by Goldman applanation tonometry. Anterior segment complications such as wound leak, IOL decentration and posterior capsule opacification, and posterior segment complications such as endophthalmitis and retinal detachment were noted. Significant inflammation was defined as inflammation needing an increase in topical steroids above the usual postoperative regimen.
Surgical Methods
Cataract surgery was performed before vitrectomy, using a microincision technique, with a 1.8 mm clear corneal incision. The IOL was inserted without enlarging the wound using a wound-assisted technique, where the cartridge tip of the lens injector projected firmly into the wound without entering the anterior chamber. Akreos AO MI-60 Micro Incision Lens (Bausch and Lomb, Rochester, NY, USA) was used in all cases except where there was a posterior capsular rupture, where a larger MA60 lens (Alcon Laboratories Inc., Fort Worth, TX, USA) was implanted in the sulcus. If the anterior chamber was formed and stable at the end of cataract surgery, the main corneal wound was not sutured, and the surgeons proceeded to the vitrectomy using the Stellaris PC Vitrectomy System (Bausch and Lomb). The vitrectomies carried out in the department had a standard approach comprising core vitrectomy and peripheral shave anterior to the equator without indentation except for retinal detachments, where a complete peripheral shave with indentation was carried out. All cases underwent an internal search to identify iatrogenic anterior retinal tears and sclerotomy-associated retinal tears towards the end of the procedure, and if present these were treated accordingly.
Patients were given prednisolone acetate 1% eye drops 2 hourly for 1 week and four times for 3 more weeks, and topical antibiotics and cycloplegics for 2 weeks.
All cases were routinely seen on day 1, 2 weeks, 6–8 weeks, and then 3 months postoperatively with variations at surgeon's discretion.
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