Local hypothermia protects the retina from ischaemic injury in vitrectomy

AIMS—Hypothermic irrigating solutions were used during vitrectomy in pressure induced ischaemic eyes so that their effects on retinal function and histological changes could be investigated.
METHODS—After anaesthetised albino rabbits underwent closed vitrectomy, their vitreous cavities were continuously irrigated for 30 minutes at a perfusion pressure of 140 mm Hg. The rabbits were divided into three groups according to their intraocular perfusion temperatures—8°C, 22°C, and 38°C. Electroretinograms were taken before and after irrigation. Glutamate levels in the vitreous were examined after irrigation. Eyes were enucleated on the seventh postoperative day and examined histologically.
RESULTS—On the seventh postoperative day, the recovery rate of a-wave amplitudes was significantly lower in the 38°C group than in the 8°C group, and that of b-wave amplitudes was significantly lower in the 38°C group than in either the 8°C or 22°C group. Retinal damage in the 38°C group revealed more severe histological impairment than in either the 8°C or 22°C group. Oedema of the inner retinal layer was significant in both the 22°C and 38°C groups. Glutamates reached peak values 30 minutes after the end of ischaemia in the 38°C group. However, no significant glutamate increases were detected 15 to 60 minutes after ischaemia in either the 8°C or 22°C group.
CONCLUSION—Local hypothermia during vitrectomy in acute ischaemic eyes appears to decrease retinal damage.

     

Blood-aqueous barrier after phacoemulsification with posterior chamber lens implantation; foldable acrylate lens vs PMMA lens-- a clinical study on 46 eyes

BACKGROUND: Cataract surgery leads to a more or less pronounced postoperative inflammation due to breakdown of the blood-aqueous barrier. This alteration of the blood-aqueous barrier can be reduced by minimally invasive surgery. The purpose of this study was to quantify the early course of the postoperative alteration of the blood-aqueous barrier following phacoemulsification with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. PATIENTS AND METHODS: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous intraocular surgeries were divided into two groups: group 1 (24 patients): phacoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneoscleral tunnel incision); group 2 (22 patients): phacoemulsification with foldable acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardized. Alteration of the blood-aqueous barrier was quantified by the laser flare-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. RESULTS: Preoperative aqueous flare values (photon counts/ms) were comparable in both groups (6.7 +/- 2.7 versus 5.6 +/- 2.7 respectively, p = 0.1). On day 1, aqueous flare in group 1 (9.7 +/- 2.9) was not statistically significantly higher than in group 2 (9.2 +/- 2.2, p = 0.2) and remained relatively constant on day 2 after surgery (9.3 +/- 3.3), whereas the aqueous flare values in group 2 decreased statistically significant (6.7 +/- 2.3, p = 0.01). Postoperatively, there was no statistically significant difference of aqueous flare values between eyes with corneoscleral tunnel incision and eyes with clear corneal incision (p = 0.7) in group 2. CONCLUSIONS: Our study shows that phacoemulsification with foldable IOL implantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especially with preexisting alteration of the blood-aqueous-barrier.     

兔眼玻璃体切割术后不同填充物晶状体混浊情况的实验研究

目的 观察兔眼单纯玻璃体切割术(平衡盐溶液填充)及玻璃体切割联合玻璃体腔硅油或C3F8气体填充后晶状体的混浊情况.方法 选用30只日本大耳白兔,左眼为术眼,随机分为3组,每组10只,A组为玻璃体切割联合玻璃体腔填充硅油组;B组:玻璃体切割联合玻璃体腔填充C3F8气体组;C组玻玻璃体切割联合玻璃体腔填充平衡盐溶液组;D组:随机抽取10只对侧未手术眼作为正常对照组.观察术后第3天、第7天、第15天、第30天、第60天各组兔眼压变化及晶状体混浊情况.结果 A组在术后7d时眼压明显升高为(16.49±2.67) mmHg(1 kPa=7.5 mmHg),与术前眼压比较差异有统计学意义(P＜0.05),B组在术后3d时眼压升高至(15.45±2.29)mmHg,与术前眼压比较差异有统计学意义(P＜0.05),C组各时间与术前眼压比较差异均无统计学意义(均为P＞0.05).A组在术后7d有3眼出现晶状体混浊,随着时间的推移最终有7眼出现晶状体混浊;B组在术后3d时有2眼出现晶状体混浊,术后7d时为7眼,术后30d后有3眼混浊的晶状体逐渐转为透明;C组在术后15 d和30d时有2眼出现晶状体混浊,正常对照组未发现晶状体混浊.A组和B组与其他两组术后晶状体混浊率比较差异有统计学意义(均为P＜0.05).结论 兔眼玻璃体切割联合玻璃体腔硅油或C3F8气体填充后眼压均有不同程度的升高;玻璃体腔填充物及眼压的改变导致眼内微环境的改变,造成晶状体混浊的发生.     

口服中药熊胆粉在兔眼内通透性的研究

目的探讨口服中药熊胆粉透过血-眼屏障到达相应靶组织的机制及其作用。方法56只家兔按照随机数字表法分成对照组8只和给药组48只。给药组再随机分成6个亚组,每个亚组8只,空腹12h给予兔中药熊胆粉100mg/kg体重灌胃,分别在灌胃后0.5、1.0、2.0、4.0、6.0、8.0h于家兔耳缘静脉采血2ml,均左眼取房水、右眼取玻璃体。对照组的实验方法同给药组,处理时间记为0h。利用高效液相色谱仪法(HPLC)测定熊胆粉中标记物牛磺熊脱氧胆酸(TUDCA)在血液、房水、玻璃体内的浓度。结果利用HPLC可准确测血液、房水、玻璃体内TUDCA浓度,其中血液中浓度为(999.1±17.2)~(1300.6±78.2)μg/ml;房水中浓度为(12.7±1.4)~(47.8±4.7)μg/ml;玻璃体中浓度为(10.8±2.9)~(57.9±7.9)μg/ml。给药组各时间点血液、房水、玻璃体中TUDCA的浓度分别与对照组相比,差异有统计学意义(P<0.01);不同时间点房水和玻璃体内TUDCA浓度之间的比较,差异无统计学意义(P>0.05)。结论口服中药熊胆粉能透过血-眼屏障到达相应靶组织,于房水和玻璃体中的浓度明显小于血液中浓度,进入房水和玻璃体的能力相近。(中华眼科杂志,2006,421023-1025)     

Local ocular hypothermia in experimental intraocular surgery

Local ocular hypothermia was evaluated in experimental open sky vitrectomy, closed vitrectomy, and anterior chamber irrigation and aspiration in 40 albino rabbits (80 eyes). The irrigating balanced salt solution was used at room temperature in control eyes and was cooled to 7 degrees C in experimental eyes. Experimental eyes demonstrated less intraocular bleeding volume, less fibrin production, and less postoperative inflammation. No detectable tissue intolerance to hypothermia was observed on short- or long-term follow-up.     

Autoradiographic localization of intravitreally- or intracamerally-injected (3H)prostaglandins

The distribution of [³H]prostaglandins in the ocular tissues of rabbits was studied using autoradiography. Also the effect of intravitreally-injected prostaglandin E₁ on the intraocular pressure and blood-aqueous barrier was investigated.To a greater extent [³H]prostaglandins were distributed in the iris-ciliary processes following administration either into the anterior chamber or into the vitreous body. In the ciliary processes, [³H]prostaglandins were found predominantly in the stroma. Intravitreally-injected [³H]prostaglandins were transported out of the vitreous body very rapidly and did not appear in the aqueous humour. The intraocular pressure and protein content of the aqueous but not of the vitreous humour were found to increase within 15–30 min of the intravitreal injection of prostaglandin E₁. The leakage of India ink in the ciliary stroma of prostaglandin-treated eyes was observed.It is suggested that the site of action of prostaglandins on the blood-aqueous barrier is the ciliary processes.     

The effects of forskolin on cyclic AMP, intraocular pressure and aqueous humor formation in rabbits

Forskolin was used to study cyclic AMP-mediated regulation of aqueous humor dynamics in rabbits. Crystalline forskolin was solubilized in oil and its pharmacological effects were studied both in vitro and following topical ocular administration. In vitro, using cultured corneal epithelial cells, forskolin rapidly stimulated cyclic AMP production and in vivo increased cyclic AMP concentration in the aqueous humor 10-fold following topical administration. The effect of topical forskolin on intraocular pressure and aqueous humor formation was determined in vivo using pneumatonometry and fluorophotometry, respectively. Forskolin caused a prolonged reduction of intraocular pressure and decreased aqueous humor formation. The ability of forskolin to potentiate the ocular hypotensive effect of epinephrine was investigated. Forskolin in combination with epinephrine caused a decrease in intraocular pressure of longer duration than either 0.1% epinephrine or 1% forskolin administered separately. Forskolin caused a small but significant increase in the permeability of the blood-aqueous barrier at the time of maximal intraocular pressure reduction. This effect on the blood-aqueous barrier may explain the inhibitory effect of forskolin on aqueous humor formation.     

原裂孔气液交换术在玻璃体手术中的应用

目的　评价玻璃体手术中利用原裂孔气液交换治疗复杂性视网膜脱离的效果。方法　对 5 1例 (5 1眼 )复杂性视网膜脱离患者采用环扎加压术加玻璃体切除术、利用原裂孔进行气液交换 (fluid- air exchange简称FA)后眼内填充 C3F8气体 ,其中 2 2例 (2 2眼 )行完整 FA术 ,2 9例 (2 9眼 )行不全 FA术。结果　术后平均随访 92 .3天观察视网膜最终复位率及视力 ,全 FA组与不全 FA组比较无明显差异 (P>0 .0 5 )。结论　利用原裂孔进行气液交换 ,并采用不同剂量 C3F8眼内填充是一种较为简单可行的手术方法。     

Effect of indomethacin on aqueous PGE2 levels in rabbits following ocular trauma

Using a highly specific radioimmunoassay, post- traumatic aqueous PGE₂ levels were measured in rabbit eyes treated with topical indomethacin aqueous solution, as well as in untreated eyes. In two groups of ten rabbits each, the surgical trauma consisted of corneoscleral incision (without injury to the iris); one of the two groups received prophylactic treatment (3 days) and therapeutic (21 days) indomethacin treatment. In two other groups of ten rabbits each, corneoscleral incision and iridectomy were performed. One group received indomethacin treatment as described above, while the other group was not treated. Surgery was performed in all 40 right eyes, the left eyes serving as controls. In 20 of the 40 left eyes, indomethacin therapy was applied. In all right and left eyes, aqueous samples were withdrawn 3 days and 21 days postoperatively, and PGE₂ concentrations were determined. The results indicate that 3 days after corneal trauma and 3 days after corneal trauma plus iridectomy, there was a highly significant reduction in the elevated PGE₂ concentrations as a result of indomethacin therapy. On postoperative day 21, indomethacin reduced even further the still slightly elevated aqueous PGE₂ concentrations without, however, completely blocking prostaglandin activity. The latter was observed even in the control animals that were not operated upon; they showed minimal PGE₂ levels in response to corneal puncture on postoperative day 3 for the purpose of drawing aqueous samples. Our study demonstrated that short-term indomethacin therapy has a significant inhibitory effect, but no unequivocal answers were found as to the value of long-term treatment.     

Intraocular effects of substance P in the rabbit

The intraocular effects of substance P (SP) were studied in rabbits by measuring the pupil diameter, intraocular pressure (IOP), and aqueous humor protein concentration. Most of the animals were pretreated with indomethacin to avoid any interaction with prostaglandins. Intracameral injection of 1 to 150 ng of SP caused strong and persistent miosis without appreciably affecting the aqueous humor protein concentration or IOP. Intracameral injection of 0.8 to 11 micrograms of SP also induced an increase in IOP (7 to 8 mm Hg) without any apparent concomitant disruption in the blood-aqueous barrier. Outflow facility of aqueous humor decreased by a mean value of 50% after intracameral injection of 0.8 to 1.5 microgram of SP. Since the increase in IOP could be prevented by iridectomy, it was probably caused by a pupillary block from the intense miosis induced by SP. No disruption in the blood-aqueous barrier could be detected after intra-arterial infusion of 10 micrograms of SP or intravitreal injection of 100 ng of SP, indicating that the ciliary epithelium was practically insensitive to exogenous SP. Topical as well as subconjunctival administration of up to 1 mg of SP did not cause any irritative response in the eye. The results show that with concentrations of SP causing intense miosis, the eye does not exhibit visible hyperemia and disruption of the blood-aqueous barrier. This finding is consistent with the hypothesis that after certain irritative stimuli, miosis is mediated by a pathway separate from the hyperemia and disruption of the blood-aqueous barrier.     

Influence of indomethacin on PGE2 in rabbit aqueous humor after YAG laser photodisruption of the iris

In an experimental study with rabbits, the influence of indomethacin on the postoperative PGE₂ level in the aqueous humor was investigated, following YAG laser traumatization of the iris. Indomethacin is a drug with an inhibitory effect on the synthesis of prostaglandins. Using albino rabbits, the right eye was treated with indomethacin eye drops three times daily for 3 days. On the 4th day, high-energy YAG laser was applied to the iris of both eyes (Q-switched Nd: YAG Laser, Model Cilco Lasertek PV 135; ten photodisruptive lesions, with 50 mJ to the midperiphery of the iris). Subsequently, the rabbits were subdivided into three groups. In group 1 the aqueous humor was removed from both eyes 12 h postoperatively; in group 2 the aqueous humor was tapped 36 h after the intervention; for group 3, it was 60 h afterwards. The results from 15 rabbits were evaluated. Local indomethacin treatment was continued until tapping of the aqueous humor. As a control, another group was used with 3 rabbits without treatment. Twelve hours after YAG laser treatment there was still a clearly significant difference in the PGE₂ concentrations between the eyes that had received indomethacin and the untreated eyes; 36 h postoperatively, the difference was no longer statistically significant, and after 60 h the PGE₂ concentrations of the treated and untreated eyes were the same.     

Effects of calcitonin gene-related peptide in the eye. A study in rabbits and cats

Calcitonin gene-related peptide (CGRP) has recently been demonstrated in sensory neurons of the eye. The purpose of the present study was to determine the effects of exogenous CGRP in the rabbit and cat eye. CGRP was injected intracamerally and the intraocular pressure was measured in cannulated eyes. The pupil diameter and the aqueous humor protein concentration were also measured. Indomethacin was used to prevent prostaglandin synthesis and tetrodotoxin (TTX) to block nerve conductance. In the rabbit eye, CGRP caused iridial hyperemia, a breakdown of the blood-aqueous barrier and increased intraocular pressure. These responses were dose-related. The increase in IOP as well as the breakdown of the blood-aqueous barrier could not be blocked with TTX or indomethacin. In cats CGRP caused a decrease in IOP and had only slight effect on the aqueous humor protein concentration. Neither in rabbits nor in cats had CGRP any detectable effect on the pupil size. Intracameral injection of 0.1 microgram (7.4 x 10(-11) moles) substance P together with 0.1 microgram (2.6 x 10(-11) moles) CGRP in rabbits caused maximal miosis but did not potentiate the intraocular effects of CGRP only. These results indicate that CGRP has marked vascular effects in the rabbit eye, causing a breakdown of the blood-aqueous barrier and increased IOP. The mechanism of this phenomenon does not involve prostaglandins neither nerve conduction, implying most likely a direct effect on the vascular smooth muscle. The mechanism of the decrease of IOP in cats remains unknown.     

In vivo human lens epithelial cell proliferation on the anterior surface of PMMA intraocular lenses.

AIMS: To study in vivo human lens epithelial cell proliferation on the anterior surface of PMMA implants and its interaction with postoperative blood-aqueous barrier breakdown in eyes undergoing cataract surgery. METHODS: A prospective study was carried out on three consecutive patient cohorts undergoing cataract surgery with intraocular lens implantation using three different surgical techniques which produce different anatomical relations between the implant and lens capsule. Specular microscopy of the anterior implant surface was used to document the natural history, topography, and density of lens epithelial cells and the laser flare and cell meter were used to measure postoperative blood-aqueous barrier breakdown. RESULTS: All groups showed lens epithelial cell proliferation onto the anterior surface of PMMA implants. This was initiated by and restricted to the region of anterior capsule-implant contact and decreased with the onset of anterior capsular opacification. Significant correlation was found in all groups between lens epithelial cell proliferation and postoperative blood-aqueous barrier breakdown. CONCLUSIONS: Human lens epithelial cell behaviour on PMMA surfaces in vivo differs from that seen in culture studies. Humoral factors in the aqueous, biomaterial properties of the implant, and its anatomical relations with the anterior and posterior lens capsule influence lens epithelial cell behaviour in vivo.     

PGE2 and leucocyte levels in aqueous humor after lens extraction and intraocular lens implantation

In order to study the inflammatory response after cataract surgery and intraocular lens implantation the leukocyte (WBC) and prostaglandin E₂ (PGE₂) levels in aqueous humor were measured in rabbit eyes at different time points (1, 3, 7, 14 and 28 days) postoperatively. In the first group lenses were implanted in the anterior chamber of the eye, without lens extraction, while in the second group the lens was removed and the IOL was placed in the capsular bag. A third group of animals was injected with 10 ng endotoxin into the vitreous in order to induce an inflammation of the uvea. In the endotoxin group high levels of WBC and PGE₂ were observed at 24 h postoperatively, followed by a decrease over time. In the intraocular lens groups WBC and PGE₂ were detected at all time points, and at higher levels compared to the endotoxin group. The WBC was high at day 1 and 3, declined over time, and then increased at day 28 postoperatively. The PGE₂ level was highest at day 3 in rabbits with anterior chamber lenses, while it peaked at day 7 in the animals with IOLs implanted in the capsular bag. In animals with the extracapsular lens extraction without an implanted IOL, the levels of WBC and PGE₂ decreased over time, and were statistically lower after one week compared with animals with an IOL placed in the capsular bag. The results demonstrate that the inflammatory response after cataract surgery persists for at least one month, probably due to surgical trauma and foreign body reactions. PGE₂ and WBC could be used to study postoperative trauma and biocompatibility of different IOL materials and designs.     

Influence of postoperative topical application of miotics after cataract extraction on intraocular pressure and the blood-aqueous barrier

Background: In the present study we evaluated the influence of topical miotics on intraocular pressure and the blood-aqueous barrier after uncomplicated phacoemulsification and PC-IOL implantation. Patients and methods: Fifty-two eyes were randomized into 2 groups: with miotics (n = 28) and without miotics (n = 24). The IOP was measured before, 6 h, 1 and 2 days after surgery. Measurement of aqueous flare was performed before and on days 1 and 2 after surgery. Patients with glaucoma, PEX or previous intraocular surgery were excluded. Results: In the group without miotics the IOP was 17.9 mm Hg (± 3.34) 6 h postoperatively; in the second group it was 15.5 mm Hg (± 3.25); P = 0.04. On the first postoperative day the IOP measured in the group without miotics was 15.3 mm Hg (± 2.70) and with miotics 13.0 mm Hg (± 2.28); P = 0.007. On the second day in the group without miotics the IOP was 13.9 mm Hg (± 3.05) and with miotics 12.60 mm Hg (± 2.19); P = 0.53. The changes in aqueous flare on the first and second day after surgery showed no significant influence of miotics on the blood-aqueous barrier (P > 0.05). Conclusions: Immediate postoperative application of topical miotics led to a small yet significant reduction of the IOP during the first 24 h after surgery. Our data suggest that there is no need for pharmacological reduction of the IOP after uncomplicated cataract surgery.      

Quantification of blood-aqueous barrier breakdown after photorefractive keratectomy for myopia

· Background: Photorefractive keratectomy (PRK) using the excimer laser is a well-established surgical technique for correction of mild to moderate myopic refraction errors in case of spectacle or contact lens incompatibility. As it is still uncertain whether this procedure causes intraocular inflammatory changes, it was the purpose of this study to quantify breakdown of the blood-aqueous barrier following PRK and to look for possible correlations with clinical parameters. · Patients and methods: Aqueous flare was quantified using the laser flare-cell meter after medical pupil dilation preoperatively and on days 1, 3 and 7 as well as 1 month and 3 months following PRK with a 193-nm excimer laser (MEL 60, Aesculap-Meditec) in 37 eyes of 22 patients. The preoperative spherical equivalents were −4.4±3.1 D (range −1.5 to −8.0 D). Pre-, intra- and postoperative treatment was standardized. · Results: Preoperatively, aqueous flare values were 3.9±0.8 photon counts/ms and showed no significant correlation with the spherical equivalent (p>0.1). Postoperatively, aqueous flare rise was very small with flare values not significantly higher than preoperative values. All postoperative flare values were below the normal limit ( <8.0 photon counts/ms). Flare was highest on day 3 after PRK surgery. There was no statistically significant correlation between aqueous flare and depth of stromal ablation. The number of aqueous “cells” did not increase following PRK at any postoperative follow-up examination. · Conclusion: Our results indicate that PRK in mild to moderate myopia does not cause a significant breakdown of the blood-aqueous barrier. Received: 28 January 1998 Revised version received: 6 April 1998 Accepted: 4 May 1998     

The effect of viscoelastic substances on postsurgical blood aqueous barrier

A postsurgical flare was evaluated with a flare-cell meter and the effect of residual viscoelastic substances on the blood aqueous barrier function was studied. The materials consisted of 100 eyes undergoing extracapsular cataract extraction and posterior chamber lens implantation using sodium hyaluronate products (Healon:Pharmacia and Opegan:Santen). The molecular weight is 1.9-3.6 million daltons in Healon and 0.9-1.2 million daltons in Opegan. According to the aqueous warm current on the 1st postoperative day, the eyes were divided into two groups; the poor current group and the normal current group. The poor current group consisted of 13 eyes had static aqueous current, probably due to residual viscoelastic substances from the clinical findings, namely a little pain, foggy general corneal edema and spontaneous recovery of the warm current without specific administrations of antibiotics. Eyes with poor current were recognized in 18% (11/62) among cases with Healon and 5% (2/38) in case with Opegan. Flare values of the poor current group were higher in 7 eyes than the highest of the normal current group on the 1st postoperative day. After the 2nd postoperative day, the median flare value of the poor current group was higher than that of the normal current group. The difference was statistically significant throughout the first week (p less than 0.02). The cell number was also higher in the poor current group on the 1st and 2nd postoperative day (p less than 0.02). These findings suggest that the residual viscoelastic materials may increase the breakdown of blood-aqueous barrier and/or interfere the barrier recovery.     

The effect of topically applied prostaglandin inhibitors on the laser-induced disruption of the blood aqueous barrier

The therapeutic effect of topically applied prostaglandin inhibitors on the laser-induced disruption of the blood-aqueous barrier was investigated in six series of five rabbits each. One series was not coagulated and served as baseline, and in a reference group laser coagulation was performed without pretreatment with a prostaglandin inhibitor. In four series the iris laser coagulation of the left eyes was preceded by topical application of a prostaglandin inhibitor. The right eyes served as controls for the contralateral effect on the blood aqueous barrier. After laser coagulation the intraocular pressure was monitored at 10-min intervals, and the anterior chamber was tapped for analysis of the protein concentration and the lactate dehydrogenase activity. Pretreatment with dexamethasone eyedrops and indomethacin eyedrops markedly blocked the laser-induced disruption of the blood-aqueous barrier. The level of protein concentration in the aqueous humor after laser coagulation was much less after pretreatment with dexamethasone or indomethacin eyedrops. The effect was significant, both for the laser-treated eyes and for the noncoagulated fellow eyes (p < 0.025). The subconjunctival pretreatment with dexamethasone 1 or 24 h before laser coagulation had no significant effect with respect to the protection of the blood aqueous barrier.     

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy

AIM: To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS: A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS: The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1st day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP(8 mm Hg) was not different between groups in the postoperative 1st day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION: Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.