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Gazi Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı PURPOSE: To subject the techniques and results of combined phacoemulsification and posterior segment surgeries which were performed in cases with cataract and posterior segment diseases.
MATERIALS AND METHOD: Fiftyone eyes of 51 cases with cataract and vitreoretinal pathology were evaluated retrospectively. Out 51 cases, 33 were male and 18 were female with a mean age of 58 years (range 19-80 years). Combined phacoemulsification and pars plana vitrectomy was performed in 12 eyes with proliferative diabetic retinopathy, 6 eyes with perforating blunt/injury, 3 eyes with vein occlusion, 23 eyes with complicated retinal detachment and in 7 eyes with other conditions. In 28 eyes scleral incisions and in 8 eyes corneal incisions were used for phacoemulsification and pars plana phacoemulsification was performed to the remaining 15 eyes. Silicone oil or gas tamponades were used in 38 eyes and foldable acrylic intraocular lens (IOL) was implanted in 9 eyes. Mean follow-up period was 6 months (range 1-12 months). Eyes were evaluated in groups with respect to final corrected visual acuity, intraoperative and postoperative anterior segment complications and anatomical success.
RESULTS: A clear intraoperative view of the fundus was obtained in all cases although mild or moderate corneal edema was developed in 9 eyes during the operation. Operation time was over 2 hours in these eyes. Corneal edema resolved in mean 3 days (range 1-5 days). Corneal edema was not seen in pars plana phacoemulsification performed eyes. Corrected visual acuity was ranged between hand movements and 0.9 postoperatively. Bullous keratopathy due to silicone oil contact in 1 eye was was a serious complication noted in the follow-up period.
CONCLUSION: Performing combined phacoemulsification and posterior segment surgery in cases with cataract and vitreoretinal diseases provides surgical facility and time gaining for the surgeon. Choosing appropiate phacoemulsification technique will enable a clear view of fundus during the surgery. The choice of procedure was mainly influenced by the hardness of the lens and whether an IOL implant was considered. If no IOL is planned and the nucleus seems too hard, phacoemulsification should be performed. In complicated retinal detachments with an expected surgery time exceeding a few hours, pars plana phacoemulsification may be a suitable choice of technique to prevent corneal edema and allowing a clear view of fundus during the surgery. Better visualisation and earlier intervention of posterior segment disorders with combined surgery may increase surgical success and prevent patients from secondary surgical procedures. Keywords : Phacoemulsification, posterior segment surgery, pars plana vitrectomy, combined surgery