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COMBINED PARS PLANA VITRECTOMY, CATARACT EXTRAC-TION AND IOL IMPLANTATION IN OUR OWN EXPERIENCE

Jerzy Nawrocki, S. Cisiecki (Lodz)

Purpose: To evaluate the effectiveness, technical feasibility and incidence of complications after combining pars plana vitrectomy, cataract removal and intraocular lens implantation.

Patients and methods: The Results of combined vitreoretinal and cataract surgery in 36 eyes of 32 patients were retrospectively analyzed. The mean follow-up period was 8.4 months.

Indications for vitreoretinal surgery included: persistent vitreous hemorrhage or vitreous hemorrhage combined with tractional retinal detachment caused by proliferative diabetic retinopathy (26 eyes), rheumatogenous retinal detachment with proliferative vitreoretinopathy (5 eyes), penetrating ocular trauma with intraretinal foreign body (1 eye), dislocated crystalline lens in the vitreous (2 eyes), nonclearing vitreous hemorrhage with traumatic retinal detachment. (1 eye). Thirty two IOL's were implanted in the capsular bag, 2 were fixated in sulcus cilliaris, 2 transsclerally sutured. All patients had clinically significant lens opacities and vitreoretinal pathology requiring pars plana vitrectomy.

Results: Postoperatively, best corrected visual acuity improved in 31 eyes (86,1 %) - by two lines or more in 20 eyes (55,5 %) - by less than two lines in 11 eyes (20,5 %), was unchanged in 4 eyes (11,1 %) and was worse in 2 cases (5,5 %). Postoperative complications included fibrin reaction in 3 eyes (8,3 %), posterior synechie of the iris in 3 eyes (8,3 %), hyphema in anterior chamber in one eye (2,8 %), vitreous hemorrhage in 4 eyes (10,8 %), neovascular glaucoma in two eyes (5,4 %), posterior capsule opacification in 4 eyes (11,1 %), redetachment of retina due to PVR - 2 eyes (5,5 %), retinal redetachment after silicone oil removal in 1 eye (2,8 %).

Conclusion: Our results confirm previous study that have shown that, in the hands of experienced cataract and vitrectomy surgeons, combined procedure can be a safe approach in treating patients with vitreoretinal pathology and significant lens opacitaties. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure, which was a well tolerated surgical procedure provided more rapid visual rehabilitation.


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