March 9, 2018 Conference
There are two options for management of the crystalline lens during planned pars plana vitrectomy surgery for macular disease; namely, phacoemulsification combined with pars plana vitrectomy, versus separate cataract surgery performed before or after pars plana vitrectomy. The major advantages of the combined approach include one surgical procedure rather than two; faster visual rehabilitation, since a combined approach avoids a delay of 1-3 months between surgeries; decreased cost to the patient and the health care system; and theoretical lower risk of endophthalmitis related to breakdown of sterility in the surgical field. Additional considerations during the combined surgical approach include sequence and location of port placement; management of the corneal wound (sutures versus rehydration); and possible need for adjustment of IOL calculations in the presence of preoperative macular disease. When presented with the option, most patients will favor the combined approach as it eliminates the need for a second surgical procedure. All options need to be carefully weighed in counseling patients regarding choices around vitrectomy surgery.