Small–incision Phacoemulsification combined with Transconjunctival Sutureless 25 Gauge Vitrectomy System (TSV) in the treatment of cataract and idiopathic epiretinal membranes (ERM)

Abstract

Abstract: : Purpose:to evaluate the safety and feasibility of using the 25 gauge TSV combined with phacoemulsification in the treatment of idiopathic ERM . Methods:: 41 eyes of 41 patients underwent combined phacoemulsification and TVS pars plana (pp) vitrectomy for cataract and idiopathic ERM. Patients underwent a detailed preoperative evaluation including Snellen best corrected visual acuity (BCA), OCT an tonometry. In the postoperative UBM of the sclerotomy was also included. Phacoemulsification was performed with small–incision bimanual technique, followed by p.p. core vitrectomy and ERM peeling. At the end of the surgery the IOL was implanted. Tunnel and sclerotomy were sutureless. Mean follow–up was 14 weeks (range 3–48)Main outcome measure were BCA, total time surgery and complications Results:Median preoperative BCA was 20/120 ( range 20/300– 20/40) , OCT macular thickness ranged from 250 to 400 microns. The median preoperative IOP was 16 mmHg ( range 10–21 mmHg). Peeling of ERM was successfully performed in all cases ( in 23 was Indocyanine green–assisted). The temporal tunnel was enlarged to 2.75 mm and a foldable IOL was positioned with an injector. No leakage from the sclerotomy was observed. Combined surgery was easy and phaco small incisions avoid any intraoperative shallowing of the anterior chamber. The mean total operating time was 28 minutes ( range 25–35). Median pars plana vitrectomy time was 19 min. The median postoperative IOP at the first postoperative day was 12 mm (range 6–21 mmHg) and after 1 month 16 mmHg (range 10–22 mmHg).UBM did not show any vitreal traction in the sclerotomy. Median BCA was 20/30 (range 20/50–20/20). Postoperative OCT macular thickness ranged from 150 to 220 microns. On the first postoperative day no inflammation or injection were observed, no discomfort was complained. A postoperative retinal detachment was observed in 1 patients during the follow–up. Conclusions:The self–sealing sclerotomy obviates the need for conjunctival peritomies and no scleral or conjunctival sutures are required, reducing the operating time The combined surgery is both safe and practical in the treatment of cataract and ERM, leading to improved patients comfort, care and management

Keywords: retina • cataract • vitreoretinal surgery