Phacoemulsification and foldable intraocular lens implantation combined with 23-gauge transconjunctival sutureless vitrectomy

Abstract

To evaluate the effectiveness, technical feasibility, outcomes, and complications of phacoemulsification and intraocular lens (IOL) implantation combined with 23-gauge transconjunctival sutureless vitrectomy. Ophthalmology Department, Calderdale Royal Hospital, Halifax, United Kingdom. This retrospective noncomparative interventional case series evaluated the results of 23-gauge transconjunctival sutureless vitrectomy combined with phacoemulsification and IOL implantation. Primary outcome measures included suture, complication, and hypotony rates; logMAR visual acuity; and intraocular inflammation. Sixty consecutive patients (60 eyes) were included. The mean visual acuity was 0.87 logMAR +/- 0.68 (SD) preoperatively and 0.46 +/- 0.34 logMAR 6 weeks postoperatively; the improvement was statistically significant (P<.0001). The 23-gauge ports were self-sealing in all eyes but 4 (6.7%), in which a single pars plana port was sutured. The mean intraocular pressure was 24.0 +/- 15.6 mm Hg 1 day postoperatively. Eight eyes (13.0%) had postoperative hypotony (<10 mm Hg); all recovered spontaneously within 24 hours. Of the eyes in which long-term tamponade was not necessary (n =12), all 3 with no endotamponade and 3 of 9 with air tamponade had postoperative hypotony; the difference was not statistically significant (P = .09). Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in managing simultaneous cataract and vitreoretinal pathology. The self-sealing incisions did not adversely affect the overall surgical or visual outcomes, led to faster visual rehabilitation, and reduced ocular inflammation. The use of air tamponade when no long-term endotamponade was necessary appeared to reduce the risk for hypotony.