Femtolaser-assisted phaco offers advantages in patients with endothelial dystrophy

“Because of frequent development or progression of cataract after vitrectomy for such indications as macular hole or epiretinal membrane, combining vitrectomy and phacoemulsification in one operation may be indicated, especially in elderly patients,” said Gisbert Richard MD, Germany. Speaking to a combined EURETINA/ESCRS session in Copenhagen yesterday, Dr Richard emphasized the difference between cataract progression in post-vitrectomy patients above the age of 60 years, in which the incidence approaches 100%, and those younger than 40 years, who have very low risk of cataract after vitrectomy.   “Phaco-vitrectomy has developed into a very safe and effective combined procedure which often improves visibility of the posterior segment during surgery, and also spares patients a second procedure later in time,” said Dr Richard.   Indeed, surgical time might not necessarily increase as compared to vitrectomy alone, as complete vitrectomy is technically simpler in a pseudophakic eye, due to the eliminated risk of lens touch during shaving of the vitreous base. Dr Richard recommends creating a long corneal or corneo-scleral tunnel that tolerates the intraocular pressure increases experienced during vitrectomy. “The tunnel should be at least 3.0mm,” he said.   “Femtolaser-assisted phaco can offer advantages in patients with endothelial dystrophy,” he added, although complicated technical equipment and additional costs might limit this development.   Dr Richard’s study of combined phaco-vitrectomy in 230 patients operated for epiretinal membrane indicated good visual outcome for what has since become routine procedure for many surgeons.