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Session Title: Complex Cases and Surgery
Session Date/Time: Monday 07/10/2013 | 14:30-16:00
Paper Time: 15:24
Venue: Forum (Ground Floor)
First Author: : S.Schulz-Key SWEDEN
Co Author(s): : U. Spandau M. Kugelberg
To evaluate complications in the anterior segment during phacovitrectomy and a long postoperative follow-up period
Department of Ophthalmology, University Hospital Uppsala, Sweden
Retrospective chart review of 425 consecutive cases of 23G pars plana vitrectomy combined with phacoemulsification and IOL implantation. The cataract surgery was performed by the vitreoretinal surgeon. Indications for surgery were retinal detachment (RD; n=126; 30%; including PVR and tractional RD), epiretinal membrane (ERM; n=89; 21%), macular hole (MH; n=81; 19%), vitreous haemorrhage (VH; n=71; 17%) and other (n=57; 13%). Endotamponade was gas in 201 cases (47%), silicone oil in 39 cases (9%) and Oxane HD in 18 cases (4%). In 311 of cases an Alcon SN60AT was implanted (73%), in 92 cases SA60AT (21%) and in 15 cases MA60BM (4%). Irisretractors were used in 7 cases (1,6%). Mean age was 65,8 years.
The most common complication during surgery was posterior capsule rupture (PCR) in 14 cases (3,29%). Intraoperative corneal edema occurred in 8 cases (1,8%), zonulolysis occurred in 3 cases (0,7%). One IOL had to be exchanged due to broken haptic. Post-operatively 35 cases developed posterior synechiae (8,2%), 29 cases had increased inflammation with fibrin in the anterior chamber (AC; 6,8%), 10 cases showed iris capture (2,3%). Bleeding in the AC occurred in 11 cases (2,5%) and resolved spontaneously. Silicone oil in the AC was noted in 16 cases (3,7%) and had to be removed. Air or gas in the AC was found in 6 cases 1,4%) and IOL tilt or subluxation occurred in 6 cases (1,4%). 8 cases developed rubeosis of the iris (1,8%). There were no cases of endophthalmitis found in this series. Mean intraocular pressure (IOP) was 15,8 mmHg before surgery, 20,5 mmHg one day after the surgery, 16,7 mmHg one week after surgery and 15,4 mmHg at final follow-up. Mean follow-up time was 32,6 month (range 4-86 month).
We found combined cataract surgery and 23G vitrectomy to be an effective method, improving visualisation of the posterior segment for the surgeon and shortening the time of rehabilitation for the patient. Nevertheless there is an increased amount of intraoperative complications compared to consecutive surgery. The most common intraoperative complication was PCR and did not result in further consequences for the patient in this setting. The postoperative complications in the anterior segment were more severe and could result in the need for further surgery or lead to visual impairment.
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