Comparison of phacoemulsification and planned extracapsular cataract extraction in combined pars plana vitrectomy and posterior chamber intraocular lens implantation.

BACKGROUND AND OBJECTIVE: To compare two kinds of cataract removal methods combined with pars plana vitrectomy and posterior chamber intraocular lens (PC-IOL) implantation. PATIENTS AND METHODS: Cataract removal was performed by either phacoemulsification or extracapsular cataract extraction (ECCE) and followed by pars plana vitrectomy and PC-IOL implantation. Between May 1996 and June 2001, 31 and 22 patients with cataract and vitreoretinal disease were treated by phacoemulsification and ECCE, respectively, combined with pars plana vitrectomy and PC-IOL implantation. Preoperative demographic data and postoperative vision, astigmatism change, and complications were analyzed. RESULTS: The mean age of patients in the phacoemulsification and ECCE groups was 62.5 and 63.4 years, respectively. Diabetes mellitus was the most common underlying disease resulting in vitreous opacity. Vision improved in 87.1% of the phacoemulsification group and 59.1% of the ECCE group. The change in astigmatism after surgery was 0.92+/-1.08 D (P = .001) in the ECCE group and 0.25+/-0.74 D (P = .087) in the phacoemulsification group. There were fewer postoperative complications, including recurrent vitreous hemorrhage, increased intraocular pressure, and iris changes in the phacoemulsification group than in the ECCE group. CONCLUSION: Phacoemulsification and ECCE combined with pars plana vitrectomy and PC-IOL implantation are both effective surgical methods to achieve better and more rapid visual rehabilitation for patients with combined cataract and vitreoretinal disease. In this study, phacoemulsification combined with pars plana vitrectomy and PC-IOL implantation resulted in greater improvement in vision, less astigmatism change, and fewer postoperative complications.     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.     

Extracapsular cataract extraction and implantation in the capsular sac during vitrectomy in diabetics]

Removal of the lens is often performed during pars plana vitrectomy for complications of proliferative diabetic retinopathy, but correction of aphakia often remains unsatisfactory. Some authors have reported posterior chamber intraocular lens implantation during pars plana vitrectomy in diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy. Some patients were operated by pars plana lensectomy and vitrectomy followed by posterior chamber intraocular lens implantation in the ciliary sulcus, others by extracapsular extraction, posterior chamber intraocular lens implantation in the ciliary sulcus, and pars plana vitrectomy. Other authors have described phacoemulsification through the limbus, pars plana vitrectomy and implantation in the capsular bag in one operation in various indications, including complications of proliferative diabetic retinopathy. We inserted a posterior chamber intraocular lens into the capsular bag in 18 eyes of 16 patients with complications of proliferative diabetic retinopathy after extracapsular cataract extraction and pars plana vitrectomy in a single session. A standard extracapsular cataract extraction was performed before pars plana vitrectomy. Sufficient anterior capsule was left in place in order to facilitate implantation in the capsular bag after pars plana vitrectomy. The anterior chamber was filled with sodium hyaluronate in order to maintain anterior chamber depth, corneal clarity, and good mydriasis during the continuation of the procedure. A standard three port pars plana vitrectomy was performed in all cases. After closure of superior sclerotomies, superior corneal incision was partially reopened, an intraocular lens specifically designed for the capsular bag with an optic size of 7 mm was inserted, and the corneal incision was closed with interrupted 10/0 sutures.(ABSTRACT TRUNCATED AT 250 WORDS)     

硅油填充眼并发性白内障的手术疗效观察

目的：观察玻璃体切割术后硅油填充眼并发白内障行超声乳化联合硅油取出及人工晶状体植入术的临床效果及安全性。方法：对32例32眼硅油填充术后并发白内障患者行超声乳化联合经睫状体平坦部切口取硅油及折叠式人工晶状体植入术。术后随访3～18（平均9）mo。结果：术后最佳矫正视力：光感～数指/眼前者3眼,0.02～0.1者10眼,〉0.1～0.2者12眼,≥0.3者7眼。所有患者均无视网膜脱离、角膜内皮失代偿、人工晶状体移位或硅油残留等。结论：白内障行超声乳化联合硅油取出及折叠式人工晶状体植入术治疗硅油填充眼并发性白内障安全、有效。     

Evaluation of results of combined pars plana vitrectomy and cataract removal

PURPOSE: Cataract often coexists with pathologies of the vitreous body. Moreover, after several months after vitrectomy, the lens becomes opaque. Lens opacities interfere with appropriate visualisation of the vitreous chamber and the eye fundus, which makes performing vitreoretinal procedures difficult. For this reason, in such patients, a combined procedure of pars plana vitrectomy and cataract extraction can be considered. This is retrospective analysis of the indications and results of combined cataract extraction and pars plana vitrectomy. MATERIAL AND METHODS: The data were based on case histories of patients who underwent combined cataract extraction and pars plana vitrectomy in the years 2001 - 2003, in the Department of Ophthalmology, Medical University of Lód?. The evaluated data included: diagnosis, pre- and postoperative best corrected visual acuity, intraocular pressure, pre- and postoperative state of the anterior and posterior segment of the eye and the employed surgical techniques. RESULTS: The examined group consisted of 40 patients (40 eyes), including 20 men and 20 women, at the age from 13 to 76 years old (mean 55.7, SD+/-14.6). The indications to vitrectomy were: vitreous haemorrhage, retinal detachment, vitreoretinal proliferations, intraocular foreign body, persistent hyaloid artery and endophthalmitis. Phacoemulsification was the most often used method of cataract extraction (34 people, 85%). In three patients cataract was removed by classical extracapsular cataract extraction (ECCE), and in further 3 patients bimanual aspiration was used. In terms of anatomical results, therapeutic success was achieved in 35 cases (87,5%). Improvement of visual acuity was observed in 28 people (70%), unchanged visual acuity in 10 people (25%), and a decrease in visual acuity in 2 patients (5%). Improvement of visual acuity at least 2 lines on Snellen's chart was achieved in 20 patients (50%).     

Results of cataract surgery in previously vitrectomized eyes

PURPOSE: To evaluate the difficulties and results of manual extracapsular cataract extraction (ECCE) and phacoemulsification cataract surgery performed in previously vitrectomized eyes. SETTING: Pécs University of Sciences, Faculty of Medicine, Department of Ophthalmology, Pécs, Hungary. METHODS: This retrospective case-control study comprised a series of 84 cataract extractions with or without intraocular lens implantation. Forty-three patients had manual ECCE and 41, phacoemulsification. The intraoperative and postoperative complications and visual outcomes in the 2 groups were analyzed and compared. RESULTS: Cataract extractions were performed a mean of 15.8 months (range 1 to 86 months) after the pars plana vitrectomy. The indications for vitrectomy were diabetic retinopathy, retinal detachment, proliferative vitreoretinopathy, giant retinal tear, macular hole, eye trauma, vitreous hemorrhage after central retinal vein occlusion, and uveitis. Primary posterior capsule fibrosis was the most common intraoperative complication, occurring in 24% of eyes. Posterior capsule rupture occurred in 5 eyes in the ECCE group and 3 in the phacoemulsification group. Zonulysis occurred in 2 and 1 eyes, respectively. A dropped nucleus occurred in 3 cases in the phacoemulsification group. Posterior capsule opacification and secondary glaucoma were the most common postoperative complications, occurring in 5 and 3 cases in the ECCE group, respectively, and in 3 and 4 cases in the phacoemulsification group. Visual acuity 6 weeks postoperatively improved or remained within 2 Snellen lines in 95% of eyes, which is comparable to data in the recent literature. CONCLUSIONS: Phacoemulsification gave better results than manual ECCE in previously vitrectomized eyes. Underlying retinal disease limited the final visual acuity.     

手术治疗糖尿病性白内障60眼临床分析

目的:分析小切口白内障囊外摘出人工晶状体植入术和超声乳化白内障吸除人工晶状体植入术治疗糖尿病性白内障的疗效及并发症。方法:选择2006-01/2010-01确诊为糖尿病性白内障患者52例60眼,Ⅱ～Ⅲ级核47眼,采用超声乳化白内障吸除后房型人工晶状体植入术;Ⅳ～Ⅴ级核13眼,采用小切口白内障囊外摘出后房型人工晶状体植入术。结果:糖尿病患者52例60眼白内障术后视力均有不同程度的提高,其中50眼(83%)术后1wk裸眼视力≥0.4。术中术后主要并发症经处理对术后视力无影响。结论:对糖尿病性白内障患者采取恰当的术式,施行小切口白内障囊外摘出人工晶状体植入术或超声乳化白内障吸除人工晶状体植入术疗效肯定。     

玻璃体切除联合白内障摘出人工晶状体植入术

目的探讨玻璃体切除联合白内障摘出及人工晶状体植入术的临床效果。方法对16例(17眼)玻璃体视网膜疾病伴有明显的白内障者实施了此联合手术。先行常规白内障囊外摘出术或晶状体超声乳化术,再行标准三通道闭合式玻璃体切除术,最后植入人工晶状体。结果术后随访2月～3年,平均13月。16眼术后视力均有不同程度提高,1眼增生性糖尿病性视网膜病变术后2月因继发新生血管性青光眼,行广泛视网膜冷凝后视力下降。术后早期16例(17眼)均有不同程度的角膜后弹力层皱褶,术后7～10d消失。2例(2眼)术后有一过性眼压升高。1例(1眼)术后2月发生新生血管性青光眼。3例(3眼)术后后囊浑浊,未影响视力。结论此联合手术的临床效果良好,具有一定的优点,但应严格掌握适应证,并要求有熟练的手术技巧。     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

Lensectomy, vitrectomy indications, and techniques in cataract surgery

Removal of a cataract during a vitrectomy can be performed to improve visualization for the surgeon or to facilitate visual rehabilitation for the patient. Because aphakic eyeglasses or contact lenses are often poor options to correct aphakia, placement of an intraocular lens during or after a vitrectomy is becoming increasingly common. A cataractous lens can be removed by pars plana lensectomy, phacoemulsification, or extracapsular cataract extraction. Options for intraocular lens placement include no intraocular lens, anterior chamber lens or sutured posterior capsular lens in the absence of capsular support, "in-the-bag" posterior capsular lens, or sulcus-fixated posterior capsular lens. This article reviews the current indications and techniques for cataract removal with or without intraocular lens placement in patients undergoing vitrectomy.     

Cataract Surgery and Transpupillary Silicone Oil Removal Through a Single Scleral Tunnel Incision Under Topical Anesthesia; Sutureless Surgery

The author evaluated the results of combined cataract extraction and transpupillary silicone oil removal through a single scleral tunnel incision, in eyes that had undergone pars plana vitrectomy with silicone oil tamponade. Twenty-four of the 46 eyes were operated on under topical anesthesia with Blumenthal mode mini-nucleus manual extracapsular cataract extraction technique (mini-nuc ECCE), and silicone oil was removed passively through planned posterior capsulorhexis via the scleral tunnel, followed by endocapsular intraocular lens (IOL) implantation. The operation was completed without any suturing. The remaining 22 eyes were similarly operated on with the same cataract extraction technique, but in these cases silicone oil was classically aspirated actively through pars plana sclerotomies. Results were evaluated by visual acuity measurement, duration of operation, and complications. The transpupillary silicone oil removal group had significantly less vitreous hemorrhage (0- 31.8%) and posterior capsule opacification (0-36.4%). Also, the mean duration of the operation was significantly shorter in this group. There was no significant difference between the two groups with regard to postoperative recurrence of retinal detachment (12.5-18.1%) and visual acuity outcome. The combination of mini-nuc ECCE with transpupillary silicone oil removal compares favorably with the combination of silicone oil aspiration through pars plana sclerotomies. This combined technique allows the surgeon to perform the operation under topical anesthesia and no sutures are required. The intervention period is shorter and no posterior capsule opacification or vitreous hemorrhage develops.     

玻璃体切除术后白内障放置后节眼内灌注行超声乳化人工晶状体植入术

目的:探讨玻璃体切除术后白内障在行超声乳化人工晶状体植入术时放置后节眼内灌注的临床效果。方法:对31例35眼玻璃体切除术后的白内障患者行超声乳化吸出及人工晶状体植入术,手术时常规放置后节眼内灌注,观察术后视力、眼底状况及手术并发症。结果:35眼中,术后最佳矫正视力≥0.5者4眼,0.3～0.4者8眼,0.1～0.2者18眼,数指～0.1者5眼;并发症:角膜轻度水肿4例,玻璃体出血1眼,脉络膜脱离1眼,术后晶状体后囊混浊2眼。结论:玻璃体切除术后发生的白内障,在选择超声乳化摘出及人工晶状体植入术的同时,放置后节眼内灌注是一种比较安全而有效的方法。     

Postoperative anterior chamber inflammation after posterior chamber intraocular lens implantation concurrent with pars plana vitrectomy and lensectomy]

The authors compared postoperative anterior chamber inflammation of triple procedure; diabetic pars plana vitrectomy, lensectomy with anterior capsule left intact and posterior chamber intraocular lens implantation anterior to anterior capsule, to those of various cataract surgeries with posterior chamber intraocular lens implantation and vitrectomies in diabetic retinopathy eyes. The inflammation was evaluated in terms of the incidence of inflammatory complications (fibrin reaction and posterior synechia of iris), and by periodical measurement of flare counts for postoperative 6 months using a laser flare-cell meter. The inflammation was more intense than those after the following 3 surgeries; phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis, extracapsular extraction and in the bag intraocular lens implantation after can opener capsulotomy, and vitrectomy alone. The inflammation, however, was less intense compared with that of another method of triple procedure; pars plana vitrectomy, phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis or can opener capsulotomy, and development of posterior synechia was rarely observed.     

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.     

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.     

Evaluation of the results of cataract extraction and lends implantation in eyes after vitrectomy

PURPOSE: To evaluate the results of cataract surgery in previously vitrectomized eyes. MATERIAL AND METHODS: In 41 eyes, that had undergone prior vitrectomy, extracapsular cataract extraction was done and intraocular lens was implanted. The average time between operations was 14.5 months (range from 2 months to 6 years). The mean follow-up was 19 +/- 12.2 months (range from 4 months to 4 years). RESULTS: Statistically significant improvement was observed in visual acuity after cataract extraction and IOL implantation, compared to the results after vitrectomy. The most frequent complication was posterior capsule opacification, which occurred in 9 eyes (22%). CONCLUSIONS: The results show, that intraocular lens implantation in eyes after vitrectomy is safe and achieved visual acuity is similar or better, than before cataract formation.     

Cataract extraction combined with trans-pupillary silicone oil drainage by planned posterior capsulorhexis

BACKGROUND: A cataract is frequently observed after pars plana vitrectomy with silicone oil endotamponade. PATIENTS AND METHODS: Forty-three consecutive patients underwent cataract surgery combined with transpupillary removal of silicone oil. After phacoemulsification of the lens material through a sclerocorneal tunnel incision, a planned posterior capsulorhexis with a diameter of 3-4 mm was performed. By injecting saline through the capsulorhexis into the vitreous cavity, the silicone oil was rinsed out. Widening of the sclerocorneal tunnel facilitated the drainage of the silicone oil through the pupil and tunnel. After ophthalmoscopic evaluation of the fundus, a plano-convex PMMA posterior chamber lens was implanted into the capsular bag or ciliary sulcus, and the corneoscleral tunnel was closed by a 10-0 nylon suture. RESULTS: Depending on the underlying retinal disease the visual acuity improved in some eyes. Silicone oil bubbles left behind in the vitreous cavity were smaller than 0.5 mm in diameter. Persisting corneal decompensation or a clinically detectable cystoid macular edema related to cataract surgery did not occur. Due to the posterior capsulorhexis, secondary cataract did not develop postoperatively. Small postoperative vitreous hemorrhages resolved during the first three post-operative days. Retinal detachment recurred in 11 eyes (11/42 or 26.2%). In one eye, dislocation of the pseudophacos occurred which had to be corrected surgically. Since the pars plana region remained untouched, direct retinal lesions in the periphery of the fundus or marked vitreous hemorrhages were not encountered. CONCLUSIONS: Silicone oil removal can be combined with cataract surgery with transpupillary drainage of the silicone oil.     

角膜地形图引导下白内障手术切口对角膜散光的矫正

目的:比较不同位置和形态的手术切口对白内障摘除术后角膜散光及裸眼视力的影响。方法:选取术前角膜散光值>1.00D的白内障患者43例52眼,将患者随机分成两组,A组患者采用超声乳化白内障吸除联合人工晶状体植入术,手术切口为位于上方10∶30～11∶30的透明角膜隧道切口。B组患者采用手法碎核白内障摘除联合人工晶状体植入术,其中角膜散光值为1.00～2.00D的患者,切口为位于角膜最大屈光度径线的直线形巩膜隧道切口,长度为6.0～7.0mm,角膜散光值>2.00D的患者,在上述直线形切口对侧角膜缘处,另作一弧形板层松解切口。分别于术后2wk,3mo随访患者,检查裸眼视力及行角膜地形图检查。结果:B组患者术后2wk,3mo裸眼视力好于A组。B组患者术后角膜散光度在术后2wk,3mo时均小于A组。结论:位于角膜最大屈光度径线的6.0～7.0mm直线形巩膜隧道切口,及此切口联合作对侧弧形板层松解切口均能有效矫正白内障术前存在的角膜散光,能够使患者获得更好的术后裸眼视力。     

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING: SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS: Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS: Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION: Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.     

Combined lens and vitreoretinal surgery in patients with traumatic cataract and intraocular foreign body

AIM: To analyze the postoperative anatomical and functional outcomes as well as complications after combined phacoemul- sification, pars plana vitrectomy (PPV), removal of the intraocular foreign body (IOFB) and intraocular lens (IOL) implantation in patients with traumatic cataract and intraocular foreign body. METHODS: Medical records of 13 patients(13 eyes) with traumatic cataract and IOFB who had undergone combined phacoemulsification, PPV, foreign body extraction and IOL implantation were retrospectively analyzed. The postoperative follow-up ranged from 2 to 12 months. The main measure- ments of outcomes were the extraction success of cataract and intraocular foreign body, intraoperative and postoperative complications and the final best corrected visual acuity (BCVA). ·RESULTS: The mean age of 13 patients(10 male, 3 female )was 36.8 years (range: 17-65 years). All eight IOFBs were removed. Four intraocular lenses were implanted after vitrectomy intraoperatively. In 5 cases, intraocular lenses were implanted during the second operation. Intraocular lenses were not implanted in 4 cases. BCVA at last ranged from 0.8 to hand movement. BCVA was 0.5 or better in four eyes, 0.1 to 0.4 in five eyes, less than 0.1 in four eyes. Intraoperative complications were encountered in 3 patients. They had vitreous hemorrhage. Postoperative complications were encounter- ed in 2 patients. They had retinal detachment. The reoperations of the two patients were successful. CONCLUSION: The combined phacoemulsification, PPV, removal of IOFB and IOL implantation is safe and effective for patients with traumatic cataract and intraocular foreign body. The visual outcome depended primarily on the corneal or scleral wound and underlying posterior segment pathology and sites.