Combined phacoemulsification and sutureless 23-gauge pars plana vitrectomy for complex vitreoretinal diseases

Background To evaluate the safety and visual outcomes of combined phacoemulsification and sutureless 23-gauge vitrectomy for concomitant cataract and vitreoretinal diseases. Methods Retrospective consecutive interventional case series. 114 eyes of 111 patients underwent combined sutureless 23-gauge vitrectomy and phacoemulsification surgery between 1 January 2006 and 1 March 2009. Main outcome measures were visual acuity and perioperative complications. Results All patients had at least 3 months follow-up (mean 263 days). The main vitreoretinal surgical indications were intractable cystoid macular oedema, epiretinal membrane and retinal detachment. Mean logMAR visual acuity improved from baseline 20/192 to 20/129 at 3 months (p = 0.005). Mean intraocular pressure (IOP) increased from baseline 15.8 mm Hg to 17.7 mm Hg (p = 0.033) on postoperative day 1 and then decreased by postoperative month 3 to 14.8 mm Hg (p = 0.019). 110 (96.5%) eyes had significant pre-existing macular disease, and 93 (81.6%) received preoperative treatments. 82 (71.9%) patients required supplemental treatment(s) at a mean of 91.5 days, most commonly intravitreal injections to reduce vascular leakage or YAG capsulotomy. Hypotony, defined as IOP < 5, was observed in four (3.5%) patients, and no patient developed endophthalmitis. Capsular tears were more frequent in eyes with a history of previous radiation or vitrectomy. Conclusions Combined phacoemulsification and sutureless 23-gauge vitrectomy surgery was safely and effectively used for cataracts and a variety of complex vitreoretinal diseases.