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A Heiligenhaus, A Holtkamp, O Vij, J Koch, A Lommatzsch, D Pauleikhoff, N Bornfeld, C Lösche, K-P Steuhl; Combined Phacoemulsification and Pars Plana Vitrectomy: Prospective Randomized Multi-center Study to Compare Clear Corneal With Scleral Incisions . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4281.
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Purpose: To compare the complications and outcome of clear corneal incision with implantation of a foldable lens with a scleral incision with implantation of a PMMA lens in combined phacoemulsification and pars plana vitrectomy. Methods: Prospective, randomized study to investigate combined phacoemulsification and pars plana vitrectomy. Group A (n=62): scleral incision and PMMA (811B, Pharmacia) implant. Group B (n=61): clear corneal incision and polyacrylic (AcrySof, Alcon) implant. The postoperative medication and follow-up was standardized. Surgical methods and intraoperative complications were noted. Follow-up visits 2 days and 3 months after surgery included visual acuity test, refractive error test, keratometry, slitlamp examination, tonometry and ophthalmoscopy. Results: The preoperative vision, the underlying retinal diseases and the vitreoretinal surgical maneuvers did not differ between the groups. Both types of incisions were sufficiently stable during surgery. No serious intraoperative complications occurred. The scar formation after previous vitrectomy rendered the scleral tunnel preparation more difficult. Two days after surgery, the incidence and quantity of cells and fibrin in the anterior chamber was lower in group B than in group A (P<0.05). Compared to group A, a transient corneal endothelial dysfunction was more common in group B (P<0.05). Three months after surgery, the astigmatic changes did not differ significantly between the groups, and posterior capsule opacification was lower in group B (p<0.05). Postoperative vision improved significantly in 63% and 61% of groups A and B, respectively. The vision was limited by the macular pathologies. Conclusion: The data show that both the clear corneal - and the scleral incisions are safe for combined cataract extraction and pars plana vitrectomy. Clear corneal incisions with a foldable implant might be preferred because of the technical ease and the reduced postoperative inflammation and posterior capsule opacification.
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