Cataract surgery combined with pars plana vitrectomy in cases of retinal diseases using a femtosecond laser: is there an advantage?

Session Details

Session Title: Presented Poster Session: Combined Cataract Surgery & Cataract Surgery Complications

Venue: Poster Village: Pod 1

First Author: : F.Hengerer GERMANY

Co Author(s): :                           

Abstract Details

Purpose:

To assess possible advantages of sutureless 23 gauge pars-plana-vitrectomy (PPV) with gas endotamponade after standard cataract surgery or Femtosecond laser-assisted cataract surgery. IOL-centration and lens tilt were exmined using Scheimpflug imaging and 360° overlap of capsulorrhexis/capsulotomy and IOL optic was observed. Intra- and postoperative anterior chamber stability, IOL position and all complications were documented and further additional surgical steps to regain a stable IOL-position or anterior chamber were analyzed.

Setting:

This prospective randomized study was performed at Ruprecht-Karls-University Eye Hospital, Heidelberg, Germany, All patients had to undergo pars plana vitrectomy, because of a retinal disease, in combination with cataract surgery and volunteered for the study.

Methods:

After randomization 66 eyes had phacoemulsification using pulsed ultrasound energy and 65 eyes were treated by laser-assisted cataract surgery with intraocular lens implantation. Both surgeries were followed by 23g PPV with gas endotamponade. All intraoperative complications were documented. Effective phaco time and further additional surgical steps to regain a stable anterior chamber or IOL-position were analyzed. IOL tilt and centration were assessed using Scheimpflug imaging. Furthermore the 360° overlap of capsulorrhexis/capsulotomy and IOL optic was observed. Corneal pachymetry, endothelial cell count, macular thickness and PCO were measured, respectively, until 12 months postoperative follow-up.

Results:

The standard cataract group with 66 eyes showed a significant higher EPT in comparison to the femtosecond laser-assisted cataract surgery (LCS) group. After gas tamponade the anterior chamber was less stable and more additional surgical steps were necessary to regain a stable IOL-position. In the standard group only 45 of 66 eyes showed 360° overlap of capsulorrhexis and IOL optic after gas tamponade and 15 needed repositioning of the IOL at the end of surgery. In the LCS group all 65 eyes showed a 360° overlap of capsulotomy and IOL optic after gas tamponade without further manipulations.

Conclusions:

Cataract surgery in combination of PPV often shows intraoperative and early post OP complications due to instable anterior chamber situations and IOL malpositioning. The capsulorhexis carried out by a Femtosecond Laser guarantees a perfect 360° overlap of the capsulotomy with the IOL. This should protect from any complications associated with an intraoperative vitreous tamponade with expanding gas/air fill

Financial Disclosure:

None