97th DOG Annual Meeting 1999
INDICATIONS FOR A COMBINED PARS-PLANA VITRECTOMY (PPV) WITH INTRAOCULAR LENS (IOL) IMPLANTATION
G. W. Nietgen, H. Elflein, J. Schmidt
Purpose: Development of cataract after PPV is not unusual, is however no indication for an initial IOL implant. Indications for combined cataract surgery in PPV are a reduced vision during surgery, resection of anterior vitreous pathology and iatrogenic damage of the lens (1). We analysed this surgical approach using our patient files to elucidate the possibilities of a combined PPV with IOL implantation
Methods: In a retrospective study 399 patients who underwent PPV in 1998 in our clinic were analysed. In 84 patients (21.1%) an IOL was concomitantly implanted. From these patients we determined in 52 patients the reason for IOL implantation as well as the surgical technique used. Besides development of visual function an overview of intraoperative and postoperative complications is being given.
Results: In all patients a posterior chamber lens (PCL) was implanted 47 times and 5 times a scleral fixation of the PCL was performed. Reasons for IOL implantation was a senile cataract (n=16), cataract with concomitant proliferative diabetic vitreoretinopathy (n=14) or status post PPV (n=8), a traumatic lens destruction (n=7) or already existing aphakia. In 45 patients phakoemulsification (PE) was performed and the IOL was placed into the bag (n=41) or the sulcus (n=4 after PE, n=2 after trauma). Simultaneous application of a cerclage was done in 14 patients. Visual recovery was going up from 0.07 pre-op to 0.18 postoperatively with a follow-up of 2.7 months. Postoperative astigmatism was with 1.40 + 0.41 dpt (95% C.I.) within the norm.
Conclusions: Combined IOL implantation during PPV is a safe method without elevated perioperative or postoperative risks. Intraoperatively better vision for the surgeon grants a higher degree of precision during the procedure. Better vision can be gained for the patient after surgery. In diabetic patients a lacking oxygen-steal phenomenon results in no higher incidence of iris neovascularisations.
1. Koenig B et al. Arch Ophthalmol 1992; 110: 1101-1104
2. Benson WE et al. Ophthalmology 1990; 97: 918-921
Zentrum für Augenheilkunde der Philipps-Universität, D - 35037 Marburg, GERMANY