Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach

Abstract

Combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation as well as the two-step procedure are safe and effective. Sequential surgery could be advantageous to minimize the postoperative anterior chamber inflammatory response.

Vitrectomía pars plana, facoemulsificación e implante de lente intraocular para el manejo de catarata y retinopatía diabética proliferativa: comparación de técnica quirúrgica combinada versus en dos tiempos

“…La cuestión de remover o no la catarata en el mismo tiempo quirúrgico con la VPP ha sido poco estudiada y la combinación es atractiva en un intento para acelerar la recuperación visual del paciente, previniendo así, la necesidad de una segunda cirugía. La cirugía combinada es preferida por algunos cirujanos, debido a que tiene algunas ventajas como un tiempo mas corto de recuperación postoperatoria, una extracción completa de las estructuras vítreas anteriores sin el riesgo de lesionar el cristalino, una buena visualización del polo posterior durante la vitrectomía y la necesidad de una sola operación, lo cual reduce las molestias del paciente y disminuye los riesgos y los costos (2,3,(13)(14)(15). Además, a los pacientes diabéticos se les realiza frecuentemente fotocoagulación panretinal como parte de la cirugía, disminuyendo el riesgo de desarrollar neovascularización de la retina y del iris (3,13,17).…”

“…Key words: Combined surgical approach, intraocular lens implantation, pars plana vitrectomy, phacoemulsification, proliferative diabetic retinopathy, two-step surgical approach. jos que comparen directamente los resultados de las cirugías combinadas con los obtenidos mediante procedimientos secuenciales; sin embargo, estos resultados son controvertidos (3,(13)(14)(15)(16)(17)(18).…”

Surgical management of the late complications of proliferative diabetic retinopathy

“…However, it is important to be cautious regarding combined procedures in patients with severe PDR because they may develop significant anterior segment complications. 23 Furthermore, the incidence of cataract formation is lower after diabetic vitrectomy than other vitrectomy procedures, particularly in younger patients. 24 It is therefore generally preferable to defer phacoemulsification cataract surgery until a visually significant cataract has developed after diabetic vitrectomy (with appropriate recognition of the potential complexity of postvitrectomy cataract surgery).…”

23- vs 20-gauge pars plana vitrectomy in combination with bimanual microincisional cataract surgery (b-MICS) for the treatment of macular hole and cataract as a one-step procedure

“…Consequently, combined vitreo-retinal and cataract surgery has been established during the 1980s and 1990s and is under discussion up to date. [2][3][4] One of the aforementioned technical developments is the employment of smallcaliber instruments first described by Fujii et al 5 in 2002. For the first approximately three decades, ppv was usually performed with 20-gauge instruments that were inserted into the vitreous via a sclerotomy through the pars plana; 6 the resulting scleral cut typically requires surgical sealing with sutures.…”

“…4 However, a reduced inflammatory reaction is considered to be an advantage of the two-step approach, 4 and therefore, small-gauge ppv is of particular interest for the one-step combination of vitreoretinal and cataract surgery.…”