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C. N. Singh, A. Tewari, G. K. Shah; Challenges With Pars Plana Vitrectomy Through Presbyopia Correcting Intraocular Lenses. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5984.
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Presbyopia correcting intraocular lenses (IOLs) are increasing in popularity among patients undergoing cataract surgery. Due to changes in the optics, performing pars plana vitrectomy through these lenses can be challenging. The purpose of this study was to identify these challenges and report strategies to minimize intraoperative complications.
Retrospective review of pars plana vitrectomies done in patients who had a presbyopia correcting intraocular lens. Outcomes analyzed included surgical indication, type of IOL, and intraoperative challenges and complications.
Four cases were identified with surgical indications of epiretinal membrane (2 cases) and retinal detachment (2 cases). The following presbyopia correcting IOLs were noted: Crystalens (Eyeonics), ReSTOR (Alcon), and ReZoom (Advanced Medical Optics). Challenges encountered intraoperatively included maintaining centration of the optic, condensation of the optic during fluid-air exchange, and altered depth perception during macular membrane peeling. Strategies to minimize intraoperative complications included using viscoelastic on the posterior surface of the IOL to minimize condensation. Also, membrane peeling on the macula surface was performed with a pinch & grab technique of the membrane in the perifoveal area, peeling circumferentially at the border of the central zone. A second membrane peel was carried out in the peripheral optical zone, staying only within this zone.
As these presbyopia correcting IOLs gain popularity among cataract patients, retinal surgeons need to be aware of the challenges of working through them when performing pars plana vitrectomy. However, with proper surgical techniques , intraoperative complications can be minimized.
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