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A.P. Ciardella, J. Olson; Combined Clear Cornea Phacoemulsification with Posterior Chamber Intraocular lens Implantation and Pars Plana Vitrectomy for Complicated Proliferative Diabetic Retinopathy in Phakic Eyes . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4072.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Proliferative diabetic retinopathy (PDR) complicated by vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) in phakic eyes is a surgical challenge. The purpose of this study is to investigate the possibility of performing combined clear cornea phacoemulsification with posterior chamber intraocular lens implantation (PC–IOL) and pars plana vitrectomy (PPV) for complicated PDR Methods: Retrospective chart review from one institution. Twenty consecutive phakic eyes underwent combined clear cornea phacoemulsification with PC–IOL and PPV for complicated PDR and were entered in the study group (Phaco + PPV group). Twenty consecutive phakic patients underwent PPV alone for complicated PDR and were entered in the control group (PPV only group). All patients and controls had a complete eye examination inclusive of Snellen best corrected visual acuity (VA), cataract grading, intraocular pressure (IOP) measurement, dilated fundus examination, and B–scan ultrasound, before surgery and at day 1, 1 week, 1 month and 3 months after surgery. For all patients and control the operative note was reviewed and the duration of the surgery was recorded Results: In the Phaco + PPV group there were 16 females and 4 males, mean age ± SD was 51.33 ± 9.08 years, mean preoperative VA ± SD was 0.034 ± 0.006, mean lens opacity was 2.2. In this group 14/20 patients had VH and 18/20 patients had TRD. In the PPV only group there were 8 females and 12 males, mean age ± SD was 54.87 ± 11.25 years, mean preoperative VA ± SD was 0.08 ± 0.12, mean lens opacity was 1. In this group 18/20 patients had VH and 4/20 patients had TRD. The median operative time was 127 minutes in the Phaco + PPV group and 86 minutes in the PPV only group. Mean postoperative VA ± SD was 0.07 ± 0.12 and 0.17 ± 0.13 in the Phaco + PPV group and in the PPV only group respectively. Mean follow up was 3 months for both groups. Conclusions: In this retrospective series from one surgeon’s experience combined phacoemulsification with posterior chamber intraocular lens implantation and pars plana vitrectomy for complicated PDR was chosen for cases with more marked vision loss, more advanced cataract and more severe retina pathology. As expected the surgical time was longer in the Phaco + PPV group. However, this procedure appeared indicated in cases of complicated PDR associated with early and or advanced cataracts.
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