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• W4237931723 abstract "Whilst we agree with some of the underlying principles of surgery expressed by MacCumber et al1MacCumber M.W. Packo K.H. Civantos J.M. Greenberg J.B. Preservation of anterior capsule during vitrectomy and lensectomy for retinal detachment with proliferative vitreoretinopathy.Ophthalmology. 2002; 109: 329-333Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar in these complex retinal detachments, we feel that certain points must be addressed. We agree with the authors of the numerous and well documented advantages of pseudophakia over aphakia (especially unilateral aphakia), and of posterior versus anterior chamber intraocular lens implantation.2Hurley C. Barry P. Combined endocapsular phacoemulsification, pars plana vitrectomy and intraocular lens implantation.J Cataract Refract Surg. 1996; 22: 462-466Abstract Full Text PDF PubMed Scopus (49) Google Scholar The authors describe a method of lensectomy, which allows for the sulcus placement of a secondary posterior chamber intraocular lens. Whilst we agree that cataract extraction and posterior chamber intraocular lens placement is both controversial and problematic when combined with pars plana vitrectomy and silicone oil injection, we do not see this as being a problem when intraocular gas is used as the tamponading agent. It has been routine for us to combine a pars plana vitrectomy with cataract extraction using clear corneal phacoemulsification with endocapsular posterior chamber lens placement in eyes with cataract and rhegmatogenous retinal detachment with or without proliferative vitreoretinopathy (gases used: 12–18% C3F8 and 30% SF6). Our series of patients have had no additional peroperative or postoperative complications over those patients who have had vitrectomy with intraocular gas tamponade without simultaneous cataract surgery. Corneal oedema, which may occur intra-operatively because of phacoemulsification surgery, does not preclude the vitrectomy from being performed safely. Neither are we aware of pupil block or corneal decompensation occurring in such patients. The safety of the combined technique has been confirmed by several other authors.2Hurley C. Barry P. Combined endocapsular phacoemulsification, pars plana vitrectomy and intraocular lens implantation.J Cataract Refract Surg. 1996; 22: 462-466Abstract Full Text PDF PubMed Scopus (49) Google Scholar, 3Senn P. Schipper I. Perren B. Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in the capsular bag a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure.Ophthalmic Surg Lasers. 1995; 26: 420-428PubMed Google Scholar, 4Koenig S.B. Mieler W.F. Han D.P. Abrams G.W. Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion.Arch Ophthalmol. 1992; 110: 1101-1104Crossref PubMed Scopus (109) Google Scholar Additionally, the patient undergoes a single anaesthetic and a single procedure thus resulting in less patient morbidity.2Hurley C. Barry P. Combined endocapsular phacoemulsification, pars plana vitrectomy and intraocular lens implantation.J Cataract Refract Surg. 1996; 22: 462-466Abstract Full Text PDF PubMed Scopus (49) Google Scholar There is also the obvious cost saving advantage of a combined technique. Advantages of phacoemulsification over pars plana lensectomy with anterior capsule preservation include faster nucleus removal, reduced risk of nucleus fragment dislocation into the vitreous, easier removal of the peripheral lens cortex, endocapsular rather than sulcus placement of the intraocular lens and reduced incidence of posterior capsule opacification and Elschnig pearl formation.2Hurley C. Barry P. Combined endocapsular phacoemulsification, pars plana vitrectomy and intraocular lens implantation.J Cataract Refract Surg. 1996; 22: 462-466Abstract Full Text PDF PubMed Scopus (49) Google Scholar An advantage over the traditional lensectomy technique also includes the preservation of the barrier between the anterior and posterior segments.4Koenig S.B. Mieler W.F. Han D.P. Abrams G.W. Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion.Arch Ophthalmol. 1992; 110: 1101-1104Crossref PubMed Scopus (109) Google Scholar We agree with the authors that the management of the lens in silicone oil filled eyes is more controversial. In their series, no patient developed pupil block despite not having an inferior peripheral iridectomy. In a larger series, we have experienced pupil block in phakic, aphakic and pseudophakic patients with oil filled eyes and will be interested to discover whether the authors too begin to experience this complication with a larger number of patients. ErratumOphthalmologyVol. 110Issue 6Preview Full-Text PDF Author replyOphthalmologyVol. 110Issue 4Preview Full-Text PDF" @default.
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• W4237931723 date "2003-04-01" @default.
• W4237931723 modified "2023-09-26" @default.
• W4237931723 title "Preservation of anterior capsule" @default.
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• W4237931723 doi "https://doi.org/10.1016/s0161-6420(02)01879-1" @default.
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