Combined cataract and vitreoretinal surgery

Cataract extraction with regular phacoemulsification surgery can be successfully combined with vitreoretinal surgery in eyes with a wide range of axial lengths and vitrectomy indications, according to Martin J Siemerink MD, PhD. Presenting on behalf of his co-author Marco Mura MD, Dr Siemerink told delegates at the ESCRS Clinical Research Symposium on cataract and macular disease in Copenhagen that combined surgery offers a lot of potential advantages. “There are some clear benefits to adopting a combined approach in terms of better visualisation, easy removal of the vitreous, avoiding the need for a second surgery, faster recovery of visual acuity, and cost-effectiveness,” he said. The downside to such an approach included possible issues with target refraction, myopic shift, accuracy of biometry and intra- and post-op complications. To examine the question further, Dr Siemerink and colleagues evaluated the refractive accuracy of intraocular lens (IOL) power calculation after phaco-vitrectomy in a retrospective comparative case series. Refraction results one month after phaco-vitrectomy or phacoemulsification were compared with predicted refractions calculated using the IOLMaster 500 and the Haigis formula. Indications for vitrectomy were macular pucker, macular hole, vitreous floaters, vitreous haemorrhage, and vitreomacular traction. The phaco-vitrectomy group comprised 133 eyes of 133 patients, and the phacoemulsification group 132 eyes of 132 patients. The refractive outcomes after phaco-vitrectomy and phacoemulsification were comparable, said Dr Siemerink. The final postoperative refraction was within ±1.00D of the preoperative refractive target in 94.9% and 94.6% of phaco-vitrectomy cases and phacoemulsification cases, respectively. Subgroup analysis found no increased risk for refractive surprises after gas tamponade or in eyes with an axial length of 26.00mm or greater. Summing up, Dr Siemerink said the study showed that standard IOL power calculation used in regular phacoemulsification surgery was accurate in phaco-vitrectomy procedures in eyes with a wide range of AL and a wide range of vitrectomy indications. No tendency toward a myopic shift was found.