Abstract
Abstract: :
Purpose: To evaluate the effectiveness of lensectomy without anterior lens capsule removal combined with pars plana vitrectomy and gas or silicone oil tamponade in the management of severe vitreoretinopathy and visually significant cataract. Methods: This was a retrospective study of 30 patients(31 eyes) with cataract and severe vitreoretinal disorders who underwent combined pars plana vitreolensectomy. All eyes had dense cataract. Vitreoretinal disorders treated included primary rhegmatogenous retinal detachment (9 eyes), recurrent retinal detachment with proliferative vitreoretinopathy (PVR)(11 eyes), PVR with silicone oil temponade( 5 eyes), proliferative diabetic retinopathy(4 eyes), vitreous hemorrhage(2 eyes). The preoperative vision acuity ranged from light perception to 20/400. All eyes underwent anterior capsule-preserved lensectomy, pars plana vitrectomy, membrane peeling, fluid-air exchange, long-acting gas or silicone oil tamponade, endolaser therapy. The anterior capsular polishing was performed in each eye. Peroperative anterior capsular rupture occurred in 4 eyes. Results: The postoperative follow-up ranged from 3 months to 21 months (mean,12 months).An anatomically successful outcome was achieved in 26 eyes(83.9%). Postoperative visual acuity improved in each case; 4 eyes had best corrected final vision acuity of 20/80; 9 eyes achieved 20/400; 8 eyes, 20/80 and 10 eyes achieved between 4/200 and 8/200. Silicone oil in the anterior chamber was detected in 2 eyes. The cornea opacification however was not observed. Postoperative elevation of intraouclar hypertension was detected in 8 eyes.Among the 27 eyes with preserved anterior capsule, 6 eyes had a transparent anterior capsule, 10 eyes had mild opacity, 8 eyes had moderate opacity, and 3 eyes had severe opacity. Conclusions: Combined anterior capsule-preserved lensectomy, pars plana vitrectomy and gas or silicone oil tamponade for patients with dense cataract and severe vitreoretinal diseases is an effective method in improving visual acuity and achieving retinal reattachment as well as preventing corneal endothelial damage. It also allows the possibility of secondary intraocualr lens implantation.
Keywords: 563 retinal detachment • 338 cataract • 357 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials