A phacovitrectomy with a clear corneal incision for a full-thickness macular hole

Combined 23-gauge vitrectomy and femtosecond laser-assisted cataract surgery

BACKGROUND

The aim of this study was to assess the safety and surgical results of femtosecond laser-assisted phacovitrectomy.

METHODS

A retrospective analysis of the medical records of patients over 50 years of age with vitreoretinal pathology, who had undergone pars plana vitrectomy using 23-gauge instruments and femtosecond laser-assisted cataract surgery and implantation of an intraocular lens, was performed at the Instituto de Microcirugía Ocular between June 2012 and September 2013. The diameter of the anterior capsulorhexis was set at 4.8 mm in cases where a gas tamponade was used and at 5 mm in all other cases. During the pars plana vitrectomy, posterior capsulotomy was performed on all eyes. An assessment was carried out of preoperative characteristics, surgical indications, postoperative results and complications. Only patients with a minimum of 3 months of follow-up were included.

RESULTS

A total of 21 eyes in 21 patients (71.4% women) were treated. Mean age (± SD) was 65.8 ± 6.4 years (range 53-76). The most common indication for surgery was epiretinal membrane (61.9%), followed by vitreous haemorrhage (23.8%) and macular hole (14.3%). The mean preoperative best corrected visual acuity (BCVA) was 0.81 ± 1.01 logMAR and the mean postoperative BCVA was 0.12 ± 0.19 logMAR (p = 0.003). 85.7% of patients improved their visual acuity. The remaining patients maintained their visual acuity. The only intraoperative complication related to femtosecond laser was 1 case of suction loss (4.8%). A patient with rhegmatogenous retinal detachment discovered during surgery required an additional circular scleral procedure and developed synechiaes in the early postoperative period (<1 month). There were no cases of subluxation of the intraocular lens. Mean follow-up was 6 months (range 3-14).

CONCLUSIONS

The application of femtosecond laser in phacovitrectomy is a safe and effective technique that presents advantages compared to conventional techniques in cases of macular pathology and/or vitreous haemorrhage.

Combined phacovitrectomy for macular hole: long-term results

BACKGROUND AND OBJECTIVE

To present the long-term results of patients undergoing combined phacovitrectomy surgery for idiopathic macular hole at a single center.

PATIENTS AND METHODS

A retrospective review of the records for 57 eyes of 53 consecutive patients who underwent combined phacovitrectomy for idiopathic macular hole during an 18-month period was completed at the Southampton Eye Unit.

RESULTS

In 45 of 57 eyes (78.9%), the macular hole closed after one surgical procedure. Forty-seven patients had a follow-up period of more than 12 months (mean = 22.1 months). In this group, the mean visual acuity (standard deviation) improved by 0.37 (+/- 0.46) logarithm of the minimum angle of resolution units. Thirty-two (68%) cases had improved visual acuity of 2 or more Snellen lines. Hole closure rate at the final follow-up examination was 87.2%.

CONCLUSION

Combining phacoemulsification and vitrectomy for an idiopathic macular hole has many benefits. It is a safe procedure and produces long-term results that are comparable to previously published series.