Preservation of anterior capsule

Abstract

Whilst we agree with some of the underlying principles of surgery expressed by MacCumber et al1 in these complex retinal detachments, we feel that certain points must be addressed. We agree with the authors of the numerous and well documented advantages of pseudophakia over aphakia (especially unilateral aphakia), and of posterior versus anterior chamber intraocular lens implantation.2 The authors describe a method of lensectomy, which allows for the sulcus placement of a secondary posterior chamber intraocular lens. Whilst we agree that cataract extraction and posterior chamber intraocular lens placement is both controversial and problematic when combined with pars plana vitrectomy and silicone oil injection, we do not see this as being a problem when intraocular gas is used as the tamponading agent. It has been routine for us to combine a pars plana vitrectomy with cataract extraction using clear corneal phacoemulsification with endocapsular posterior chamber lens placement in eyes with cataract and rhegmatogenous retinal detachment with or without proliferative vitreoretinopathy (gases used: 12–18% C3F8 and 30% SF6). Our series of patients have had no additional peroperative or postoperative complications over those patients who have had vitrectomy with intraocular gas tamponade without simultaneous cataract surgery. Corneal oedema, which may occur intra-operatively because of phacoemulsification surgery, does not preclude the vitrectomy from being performed safely. Neither are we aware of pupil block or corneal decompensation occurring in such patients. The safety of the combined technique has been confirmed by several other authors.2,3,4 Additionally, the patient undergoes a single anaesthetic and a single procedure thus resulting in less patient morbidity.2 There is also the obvious cost saving advantage of a combined technique.