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G. Kieselbach, M. Kralinger, W. Goettinger; Combined Vitrectomy and Lens Implantation With Microincision Cataract Surgery in Presbyopic Eyes Compared to Sclerocorneal Incision Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):754.
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Purpose: The aim of the study was to compare the microphaco incision cataract surgery in combination with a vitrectomy with a sclerocorneal incisision cataract extraction in combination with vitrectomy in regard to its feasability and safety. Methods: A total of 82 eyes of 58 patients who underwent surgery due to retinal detachment, diabetic retinopathy and diabetic macular edema at the Ophthalmology department of the Medical University in Innsbruck, Austria were included in this retrospective interventional case series. Patients who were operated between 2000 and 2003 were randomly assigned either to the group who underwent combined surgery using corneocsleral incision or to the group using microphaco incision. . For both, the cool microphaco procedure and sclerocorneal phako combined with the vitrectomy a high speed cutter, provided by OS3 System (Örtli) was used. Results: Intraoperative complications were flattening of the anterior chamber, irisprolaps and miosis. Postoperative complications compromized iriscapture, hemorrhages in the anterior and posterior chamber and air and silicone bubbles in the anterior chamber inspite of narrowing of the pupil after acetylcholin installation. In total 13 patients needed a second surgical procedure: 6 patients underwent a second vitrectomy, 5 patients underwent silicone oil removal, 4 anterior chamber revision and 2 transscleral cyclo photocoagulation. The mean time between primary oil filling and oil removal was 7.7 months. Mean ocular tension was found to be 15.3mmHG. No correlation could be found between surgery indication and postoperative tension. No severe sight threatening complications were observed in either group. Furthermore statistical analyses revealed no significant difference comparing both groups in respect to the incidence of complications. Especially no higher incidence of anterior chamber flattening occurred in the microincision group. The visual results in both treatment groups were equivalent. Conclusions: Both surgical techniques provide an enhanced and excellent perioperative visualisation and safe access to the anterior retina. Visual rehabilition in most of the patients was obtained soon after surgery allowing the patients to return to work very rapidly.The results demonstrate the advantages of the combined surgical procedure in general and enforce the equivality of the double procedure using microphaco incisions in respect to efficacy, feasability and most important to safety
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