Abstract
Purpose
To report intra-and postoperative complications in pars plana vitrectomy, phacoemulsification and intraocular lens implantation. A comparison of the combined versus two step surgical approach is given.
Method
Medical records and operative notes of 111 eyes with combined surgery and 50 eyes with sequential surgery were retrospectively analysed. Subgroup analysis was performed to evaluate differences in disease groups, the use of endotamponading or endolaser and cryocoagulation. Postoperative follow-up time was between 3 and 18 months.
Results
Combined surgery: 64 eyes (57.5%) showed no complications. 17 eyes (15.3%) showed transient intraocular pressure rise, 17 eyes (15.3%) fibrinous exudation in the anterior chamber. Posterior capsule tears occurred in 7 eyes (6,3%), formation of posterior synechia was observed in 7 eyes (6.3%). IOL dislocation was seen in 3 eyes (2.7%), heavy covering of macrophages in 3 eyes (2,7%). Rare complications included silicon oil efflux into the anterior chamber (1.8%), anterior chamber hemorrhage (1,8%) and iris incarceration into the corneoscleral incision (0,9%). One eye needed explantation of the IOL during the follow-up. Sequential surgery: 31 eyes (62%) showed no complication. Transient intraocular pressure rise occurred in 14 eyes (28%), fibrinous exudation in 2 eyes (4%). Formation of posterior synechia was observed in 1 eye (2%), posterior capsule tears occurred in 4 eyes (8%). Dislocation of the IOL was seen in 1 eye (2%). Subgroup analysis revealed fibrinous exudation in the anterior chamber to be significantly more frequent after combined surgery, particularly in cases of proliferative diabetic retinopathy.
Conclusion
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.
Similar content being viewed by others
References
Biro Z, Kovacs B (2002) Results of cataract surgery in previously vitrectomized eyes. J Cataract Refract Surg 28:1003–1006
Blodi BA, Paluska SA (1997) Cataract after vitrectomy in young patients. Ophthalmology 104:1092–1095
Chang MA, Parides MK, Chang S, Braunstein RE (2002) Outcome of phacoemulsification after pars plana vitrectomy. Ophthalmology 109:948–954
Chung TY, Chung H, Lee JH (2002) Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes. J Cataract Refract Surg 28:2001–2005
De Bustros S, Thompson JT, Michels RG, Enger C, Rice TA, Glaser BM (1988) Nuclear sclerosis after vitrectomy for idiopathic epiretinal membranes. Am J Ophthalmol 105:160–164
Demetriades AM, Gottsch JD, Thomsen R, Azab A, Stark WJ, Campochiaro PA, de Juan E Jr, Haller JA (2003) Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol 135:291–296
Federman JL, Schubert HD (1988) Complications associated with the use of silicone oil in 150 eyes after retina-vitreous surgery. Ophthalmology 95:870–876
Grusha YO, Masket S, Miller KM (1988) Phacoemulsification and lens implantation after pars plana vitrectomy. Ophthalmology 105:287–294
Honjo M, Ogura Y (1998) Surgical results of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation for complications of proliferative diabetic retinopathy. Ophthalmic Surg Lasers 29:99–105
Hsuan JD, Brown NA, Bron AJ, Patel CK, Rosen PH (2001) Posterior subcapsular and nuclear cataract after vitrectomy. J Cataract Refract Surg 27:437–444
Koenig SB, Mieler WF, Han DP, Abrams GW (1992) Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion. Arch Ophthalmol 110:1101–1104
Lacalle VD, Garate FJO, Alday NM, Garrido JAL, Agesta JA (1998) Phacoemulsification cataract surgery in vitrectomized eyes. J Cataract Refract Surg 24:806–809
Lahey JM, Francis RR, Fong DS, Kearney JJ, Tanaka S (2002) Combining phacoemulsification with vitrectomy for treatment of macular holes. Br J Ophthalmol 86:876–878
Lahey JM, Francis RR, Kearney JJ (2003) Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases. Ophthalmology 110:1335–1339
Martin KR, Burton RL (2000) The phacoemulsification learning curve: per-operative complications in the first 3000 cases of an experienced surgeon. Eye 14:190–195
Melberg NS, Thomas MA (1995) Nuclear sclerotic cataract after vitrectomy in patients younger than 50 years of age. Ophthalmology 102:1466–1471
Mueller AJ, Klinger K, Tribus C, Kampik A (2004) Combined anterior and posterior segment surgery. Ophthalmologe 101:667–674
Pinter SM, Sugar A (1999) Phacoemulsification in eyes with past pars plana vitrectomy: case-control study. J Cataract Refract Surg 25:556–561
Pollack A, Landa G, Kleinman G, Katz H, Hauzer D, Bukelman A (2004) Results of combined surgery by phacoemulsification and vitrectomy. Isr Med Assoc J 6:143–146
Rosen PH, Rahman R (2002) Pupillary capture after combined management of cataract and vitreoretinal pathology. J Cataract Refract Surg 28:1607–1612
Senn P, Schipper I, Perren B (1995) Combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure. Ophthalmic Surg Lasers 26:420–428
Shinoda K, O'hira A, Ishida S, Hoshide M, Ogawa LS, Ozawa Y, Nagasaki K, Inoue M, Katsura H (2001) Posterior synechia of the iris after combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Jpn J Ophthalmol 45:276–280
Smiddy WE, Michels RG, Stark WJ, Maumenee AE (1988) Cataract extraction after retinal detachment surgery. Ophthalmology 95:3–7
Sneed S, Parish RK II, Mandelbaum S, O'Grady G (1986) Technical problems of extracapsular cataract extraction after vitrectomy (letter). Arch Ophthalmol 104:1126–1127
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Treumer, F., Bunse, A., Rudolf, M. et al. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach. Graefe's Arch Clin Exp Ophthalmo 244, 808–815 (2006). https://doi.org/10.1007/s00417-005-0146-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-005-0146-9