Korean J Ophthalmol.  2006 Sep;20(3):147-150. 10.3341/kjo.2006.20.3.147.

A Phacovitrectomy with a Clear Corneal Incision for a Full-Thickness Macular Hole

• Kim NJ
• Yu HG

• KMID: 754570
• DOI: http://doi.org/10.3341/kjo.2006.20.3.147

Abstract

PURPOSE: To describe the results of a pars plana vitrectomy, combined with phacoemulsification, using a sutureless, superotemporal, clear corneal incision for patients with a macular hole. METHODS: This study reviewed the records of 22 patients (22 eyes) who underwent a phacoemulsification with the insertion of an acrylic intraocular lens, using a 3.2 mm superotemporal clear corneal incision and a pars plana vitrectomy with an internal limiting membrane peeling in one session, for the treatment of a macular hole. RESULTS: All 22 patients had their macular holes closed using the combined surgical procedures. The mean preoperative visual acuity was 0.086, and the mean postoperative visual acuity was 0.173. This improvement was statistically significant (paired Student's t-test, p<0.05). No patients developed posterior capsular opacity, retinal detachment, or a cystoid macular edema. The surgically induced astigmatism (SIA) was 0.808 diopters (0.808+/-0.761) two months after surgery. CONCLUSIONS: Combining cataract surgery with vitrectomy can achieve visual rehabilitation in the early postoperative period without requiring post-vitrectomy cataract surgery. A sutureless clear corneal incision, used in this procedure, can minimize the SIA and promote postoperative wound healing. If sutureless, transconjunctival, pars plana vitrectomy can be used more widely in the future, then the simplified, combined cataract surgery using a small clear corneal incision will also become more common, hence decreasing operation time, and hastening postoperative recovery.

Keyword

Cataract surgery; Clear corneal incision; Macular hole; Vitrectomy

MeSH Terms

Vitrectomy/*methods
Visual Acuity
Treatment Outcome
Severity of Illness Index
Retinal Perforations/complications/pathology/*surgery
Phacoemulsification/*methods
Middle Aged
Male
Lens Implantation, Intraocular/methods
Humans
Follow-Up Studies
Female
Cornea/*surgery
Cataract/*complications
Aged, 80 and over
Aged
Adult

Reference

1. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991. 109:654–659.

2. Thompson JT, Glaser BM, Sjaarda RN, Murphy RP. Progression of nuclear sclerosis and long-term visual results of vitrectomy with transforming growth factor beta-2 for macular holes. Am J Ophthalmol. 1995. 119:48–54.

3. Freeman WR, Azen SP, Kim JW, et al. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Arch Ophthalmol. 1997. 115:11–21.

4. Lahey JM, Francis RR, Fong DS, et al. Combining phacoe mulsification with vitrectomy for treatment of macular holes. Br J Ophthalmol. 2002. 86:876–878.

5. Gottlieb CC, Martin JA. Phacovitrectomy with internal limiting membrane peeling for idiopathic macular hole. Can J Ophthalmol. 2002. 37:277–282.

6. Hilton GF, Josephberg RG, Halperin LS, et al. Office-based sutureless transconjunctival pars plana vitrectomy. Retina. 2002. 22:725–732.

7. Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002. 109:1814–1820.

8. Fugii GY, DeJuan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002. 109:1807–1812.

9. Minassian DC, Rosen P, Dart JK, et al. Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomized trial. Br J Ophthalmol. 2001. 85:822–829.

10. Simsock PR, Scalia S. Phacovitrectomy without prone posture for full thickness macular holes. Br J Ophthalmol. 2001. 85:1316–1319.

11. Hayashi K, Nakao F, Hayashi F. Corneal topographic analysis of superolateral incision cataract surgery. J Cataract Refract Surg. 1994. 20:392–399.

12. Simsek S, Yasar T, Demirok A, et al. Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoemulsification. J Cataract Refract Surg. 1998. 24:515–518.

13. Matsumoto Y, Hara T, Chiba K, Chikuda M. Optimal incision sites to obtain an astigmatism-free cornea after cataract surgery with a 3.2mm sutureless incision. J Cataract Refract Surg. 2001. 27:1615–1619.

14. Cheng L, Azen SP, El-Bradey MH, et al. Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole surgery. Am J Ophthalmol. 2001. 132:881–887.

15. Biro Z, Kovacs B. Results of cataract surgery in previously vitrectomized eyes. J Cataract Refract Surg. 2002. 28:1003–1006.

16. Roman SJ, Auclin FX, Chong-Sit DA, Ullern MM. Surgically induced astigmatism with superior and temporal incisions in cases of with-the-rule preoperative astigmatism. J Cataract Refract Surg. 1998. 24:1636–1641.

17. Gross RH, Miller KM. Corneal astigmatism after phacoemulsification and lens implantation through unsutured scleral and corneal tunnel incisions. Am J Ophthalmol. 1996. 121:57–64.

18. Beltrame G, Salvetat ML, CHizzolini M, Driussi G. Corneal topographic changes induced by different oblique cataract incisions. J Cataract Refract Surg. 2001. 27:720–727.

19. Domniz YY, Cahara M, Avni I. Corneal surface changes after pars plana vitrectomy and scleral buckling surgery. J Cataract Refract Surg. 2001. 27:868–872.

20. Azar-Arevalo O, Arevalo JF. Corneal topography changes after vitreoretinal surgery. Ophthalmic Surg Lasers. 2001. 32:168–172.

21. Lavery KT, McDermott ML, Ernest PH, et al. Endothelial cell loss after 4 mm cataract surgery. J Cataract Refract Surg. 1995. 21:305–308.

22. Nishida T, Yagi J, Fukuda M, et al. Spontaneous persistent epithelial defects after cataract surgery. Cornea. 1987. 6:32–37.