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S. Teymoorian, N. R. Sabates, M. A. Cassell, A. K. Poulose, F. N. Sabates, Sr.; Combined Clear Cornea Phacoemulsification, Intraocular Lens Implantation and 25-Gauge Pars Plana Vitrectomy versus Only 25-Gauge or 20-Gauge Vitrectomy for Vitreoretinal Pathology. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2550.
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Vitreoretinal surgeons commonly face the dilemma of having patients with visually significant cataracts coexisting with vitreoretinal pathology that combine to reduce the best-corrected visual acuity (BCVA). The common approach to this situation was to perform two procedures at different times including cataract extraction with intraocular lens placement and pars plana vitrectomy. However, this study assesses the effectiveness of combination 25-gauge pars plana vitrectomy (PPV) with clear corneal cataract extraction (CE) and posterior chamber intraocular lens implantation (PCIOL) against only 20- or 25-gauge PPV for vitreoretinal pathology without CE by analyzing surgical outcomes and complication rates.
IRB approved, retrospective chart review of consecutive, interventional cases.
Charts from January 2006 through January 2009 requiring surgery for macular hole or pucker with or without visually significant cataract in an Ambulatory Surgical Center were reviewed. The patients were stratified into three groups: those that had a combination of CE and 25-gauge PPV (Group 1), only 20-gauge PPV (Group 2), and only 25-gauge PPV (Group 3). Demographic information, pre- and post-operative BCVA, and surgical complications were collected. Complications that were monitored included retinal detachments and hypotony among others. SigmaStat 3.5 (Systat, Point Richmond, CA) was used for statistics.
In total, 407 eyes from 374 patients were reviewed. 40 eyes were excluded secondary to coexistence of proliferative diabetic retinopathy. This left 64 eyes for Group 1, 88 eyes for Group 2, and 215 eyes for Group 3. The following were BCVA with standard deviation in logMAR pre-operatively and at 6 month follow-up: Group 1 was 0.88+/-0.42 and 0.43+/-0.25, Group 2 was 1.05+/-0.51 and 0.62+/-0.35, and Group 3 was 0.98+/-0.48 and 0.57+/-0.32, respectively. There was no statistical significance in BCVA between the groups while the types and rates of surgical complications were comparable.
The use of combination 25-gauge PPV and CE with PCIOL provides similar surgical outcomes and complications compared to solo 20- and 25-gauge PPV. This combination allows multiple pathologies to be addressed during the same operation. Surgeons and patients now have another option that offers comparable results with similar risk and the added benefit of only requiring a single sitting without the secondary risk, inconvenience, or cost of an additional surgery.
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