Combining phacoemulsification and vitrectomy in patients with proliferative diabetic retinopathy.

PURPOSE OF REVIEW: Modern vitrectomy and cataract extraction techniques have reached levels not imagined 20 years ago. Combining pars plana vitrectomy with phacoemulsification and posterior capsulectomy now has the potential to condense three separate procedures: pars plana vitrectomy, phacoemulsification, and YAG capsulotomy into one procedure. Interest in combined surgery is increasing as reports in the literature documenting its safety and efficacy continue to be published. The purpose of this article is to review the recent trends in combined surgery. RECENT FINDINGS: Studies have shown that when comparing sequential surgery to combined surgery, there is no significant difference in visual outcome. Multiple reports confirm the safety of combined surgery in patients with proliferative diabetic retinopathy. SUMMARY: In select patients with diabetes, combining vitrectomy with phacoemulsification and posterior capsulectomy allows patients who often have bilateral vitreoretinal disease to come to a stable postoperative vision in the eye requiring vitreous surgery much earlier than three separate procedures spread out over months or years.

Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases.

PURPOSE: To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. DESIGN: Retrospective, consecutive, noncomparative, interventional case series. PARTICIPANTS: Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. METHODS: A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. MAIN OUTCOME MEASURES: Vision, number of secondary procedures, and complications. RESULTS: Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). CONCLUSIONS: Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.