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Presbyopic phacovitrectomy
R Ling1, P Simcock, J McCoombes
1West of England Eye Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK.
Aim:
To review the results and complications of combined phacoemulsification and vitrectomy in presbyopic patients.
Methods:
Retrospective review of 90 consecutive presbyopic patients who underwent phacoemulsification and vitrectomy for primary rhegmatogenous retinal detachment (RRD) (21), redo-RRD (seven), stages 2 and 3 full thickness macular holes (FTMH) (38), stage 4 FTMH (six), idiopathic epiretinal membrane (ERM) (11), proliferative diabetic retinopathy (PDR) (three) and vitreous haemorrhage secondary to branch retinal vein occlusion (BVO) (four).
Results:
Lens opacity was absent or mild in 84.5% of patients. Reattachment rates for primary RRD and redo-RRD after one procedure were 90.5% and 71.4% and final reattachment rates were 95.2% and 100%, respectively. Macular hole closure rate was 89.5% for stage 2 and 3 FTMH and 83.3% for stage 4 FTMH. There was significant improvement in the median logMAR visual acuity from 1.00 preoperatively to 0.48 postoperatively for the whole cohort (p<0.001, Wilcoxon test). Postoperative complications included fibrinous uveitis (13.3%), iris bombe (2.2%), IOL/iris capture secondary to gas overfill (1.1%), and posterior capsule opacification (51.1%).
Conclusion:
Combined phacoemulsification and vitrectomy is a safe and desirable option in the management of phakic, presbyopic patients with vitreoretinal pathologies that warrant vitreous surgery, even in the absence of significant lens opacity.