Novel approach for phacoemulsification during combined phacovitrectomy

Abstract

PurposeTo evaluate the safety and efficacy of surgeon’s superior sitting position during temporal clear corneal incision (TCCI) phacoemulsification, with a 90° working angle, during combined phacovitrectomy.MethodsProspective interventional case series were performed on 65 eyes of 63 patients. TCCI phacoemulsification was done in all cases (whether right or left eyes), while the surgeon was sitting superiorly to the operating table.Outcome measures includedShift in sitting position, keratometric astigmatism, surgically induced astigmatism, posterior capsule integrity, and intraocular lens centration.ResultsPhacoemulsification was performed completely in all cases (100%). Shift in position to temporal sitting position happened in two cases (3%). The keratometric astigmatism showed mean changes of 1.09 D (0.25–3.75 D) to 0.84 D (0.00–3.25 D) at 1 month, which remained stable at 6 months; 0.84 D (0.16–3.21 D). The surgically induced astigmatism was 0.25 DC (−0.50 to 1.0 DC) at 1 month, which stayed stable at 6 months; 0.25 D (−0.63 D to 0.98 D). Posterior capsular rupture occurred in one case (the second case) (1.5%). The intraocular lens was centered in all cases (100%).ConclusionSuperior sitting TCCI phacoemulsification, with a wide working angle, during combined phacovitrectomy proved safe and easy, without the burden of changing and disrupting the operative setting. The anatomical and optical outcomes were acceptable.

Femtosecond Laser-Assisted Cataract in Vitreoretinal Surgery

“…Vitrectomy is known to cause cataract progression due to the surgery itself or the intraoperative lens manipulation (7). The combined procedure eliminates the need for cataract extraction in a vitrectomized eye, which may be more challenging because of instability of the zonules and posterior capsule, absence of vitreous support, and adherent posterior subcapsular plaques (4). Moreover, phacoemulsification allows better access to the retinal periphery during the vitrectomy and better visualization when there is significant lens opacity (2–3–4).…”

“…Vitrectomy using small-gauge (23-G, 25-G, or 27-G) instrumentation has some advantages, including decreased operating time and reduced inflammation and postoperative pain, compared with conventional 20-G vitrectomy (1). Combined small-gauge vitrectomy and phacoemulsification is an effective and safe surgical procedure, which is becoming increasingly common in the management of vitreoretinal pathologies associated with cataract (2)(3)(4).…”

Comparison of Phaco Energy and Complications for Conventional Phacoemulsification and 25-gauge Phacovitrectomy Surgery

“…Combined phacoemulsification and vitreoretinal surgery offers several advantages including adequate visualization of the posterior segment which is mainly essential for macular surgery, adequate access to the vitreous base in eyes with retinal detachment, avoiding the need for another surgery, more rapid visual recovery after one surgery [1][2][3][4][5].…”