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Combined Phacoemulsification, Intraocular Lens Implantation, and Vitrectomy for Eyes With Coexisting Cataract and Vitreoretinal Pathology |
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| Combined Phacoemulsification, Intraocular Lens Implantation, and Vitrectomy for Eyes With Coexisting Cataract and Vitreoretinal Pathology |
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作者：li Wensh… 文章来源：Eye Hospital of Wenzhou Medical College 325027 点击数：1083 更新时间：2005/6/13 20:48:28 
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| ●PURPOSE: To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology.
●METHODS: 52 eyes of 68 patients who underwent combined phacoemulsification, IOL implantation, and vitreoretinal surgery during the study period. Patients with less than 6 weeks’follow-up were excluded. The preoperative clinical data obtained for each patient included age, sex, preoperative visual acuity, type and extent of cataract, vitreoretinal disease, and previous laser or intraocular surgeries. Intraoperative data included type of IOL, surgical incision site; vitreoretinal procedure performed, and intraoperative complications. The postoperative data obtained included visual acuity with postoperative refraction, length of follow-up, postoperative complications, and subsequent surgical procedures.
●RESULTS: In all, 52 eyes of 68 patients were identified. Patient ages ranged from 21 to 85 years (mean 64). Twenty-one eyes had diabetic retinopathy; 13 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 18 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 0.6 to light perception and postoperative vision ranged from 1.0 to no light perception. In 46 patients vision improved, in 4 there was no change, and in 2 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL.
● CONCLUSIONS: Combined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.
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