Combined Vitrectomy and Clear Corneal Phacoemulsification in Patients with Vitreoretinal Diseases

Abstract

Background: The aim of the study was to examines the results, intraoperative and postoperative complications, and visual outcomes of combined phacoemulsification and pars plana vitrectomy (PPV) under sub-Tenon’s anesthesia. Methods: This retrospective study included 56 eyes of 56 patients who underwent combined vitrectomy and clear corneal cataract surgery for posterior segment disease. All patients had applied randomly. A 50:50 mixture of 2% lidocaine and 0.75% bupivacaine was applied for sub-Tenon’s anesthesia followed by a standard phacoemulsification-IOL procedure and three-port vitrectomy. Visual outcomes and surgical complications of patients were measured the during the mean 9 months after surgery. Results: Preoperatively, indications for 12 (21%) of the patients were retinal detachment, 25 (45%) were diabetic intravitreal haemorrhage, and 19 (34%) were intravitreal haemorrhage related to retinal vein occlusion for combined surgery. None of the cases in this study experienced intraoperative capsule rupture, but two cases had iatrogenic retinal tearing. In the first postoperative visit, none of the patients exhibited hypotony, corneal oedema was observed in five patients and four patients had elevated intraocular pressure (IOP). None of the patients who received the perfluoropropane gas injection had elevated IOP. Eleven patients had the same visual acuity and 45 patients had improved visual acuity at the end of the follow-up period. Postoperatively, four cases developed 160-180° posterior synechiae due to inflammation, and one case developed 360° posterior synechiae and elevated intraocular pressure. Posterior capsule opacification developed in three cases, and none of the patients experienced IOL decentralization. Conclusion: Combined surgery, 23-gauge vitrectomy and clear corneal phacoemulsification, under sub-Tenon’s anesthesia was safe and effective in patients with posterior segment disease.