March 9, 2018 Conference


Combining Cataract Surgery with Vitrectomy Surgery

Robert Millay, University of Vermont Dept of Surgery/Ophthalmology (Presenter)

Arguments and Evidence to support separating phaco/IOL and vitrectomy will be presented.  Minimizing potential for surgical complications involves playing to our strengths and avoiding more surgery than is necessary in an effort to achieve the best results for our patients.  KEEPING IT SIMPLE!

Combining cataract surgery with vitrectomy will at a minimum prolong surgery and invites the immediate potential for anterior segment problems including corneal edema and pupillary constriction or distortion or inflammation that may make an otherwise straight forward vitrectomy surgery much tougher and more traumatic and more complicated.  Splitting the surgery into its component parts may preserve lens function for an extended period of time and sometimes indefinitely when the vitrectomy is done first or if cataract surgery is done first, may avoid vitrectomy altogether if the patients visual needs prove to be met by the cataract surgery alone.

Macular pucker induced distortion, thickening or edema has the potential to cause inaccuracies in IOL power determination.  this could be alleviated by doing the pucker surgery first , allowing the macula to "defervesce" and then performing a more accurate calculation.

Cataract formation is probably the most common "complication" of vitrectomy surgery.  Innovative approaches to certain macular surgeries can be done to moderate the cataractogenic nature of vitrectomy.

Certainly one can concede that there are instances where strong patient preference or cost may push one to do combined anterior and posterior segent surgery.  In general more surgery equals longer OR times, more risk of complications and more inflammation.  The KISS principle of surgery and life dictates we follow a staged approach as necessary in the setting of surgical vitreous pathology.