Combined cataract and vitrect surgery

written by Dr Kenneth Fong Choong Sian on 23 June 2012

 

Most patients who require vitrectomy for diseases like macula hole, epiretinal membrane and retinal detachment are aged more than 50 years old. By that age, most of us would have some cataract in our eyes. A cataract is clouding of the lens in our eye and the most common cause is old age.
 
Vitrectomy surgery makes cataract develop faster
It is now well recognized that removing the vitreous from your eye can make cataract develop faster. This is probably due to oxygen levels increasing in the eye leading to early cataract formation. Within 2 years after a vitrectomy, almost 90% of patients will develop a cataract.For patients who already have cataract and have a retina problem requiring a vitrectomy, it makes sense to combine the two operations and do them at the same time.
Combining the two operations together is elegant and simple. The cataract can first be removed and an intraocular lens (IOL) inserted via the standard phacoemulsification procedure. The second operation is performed after that. This is seamless and takes only an extra 10 minutes.
 
Cataract surgery after vitrectomy surgery has higher risks
If cataract surgery is performed months or years after vitrectomy has been done in that eye, there is an increased risk of complications like posterior capsule rupture and lens dropping to the back of the eye.  Therefore, it may be better to remove the cataract at the same time as the vitrectomy operation to save the hassle of a second procedure later with increased risks of complications.
 
There are some issues with doing both operations at the same time. Firstly, if there is gas injected into the eye during the vitrectomy, this may push the IOL out of its original position. This can result in the post-operative refraction to be inaccurate and the patient may need to wear glasses later for sharper vision. Secondly, there is added cost and time doing both at the same time but this is still more cost-effective then doing 2 seperate operations.
 
I normally discuss these options with my patients and most patients usually choose to have combined surgery due to the benefit and convenience of having both done at the same time.
 
Have a great weekend!
 
Dr Kenneth Fong Choong Sian
Consultant Ophthalmologist and Vitreoretinal Surgeon
Kuala Lumpur, Malaysiaomy surgery