Abstract

DO.06.13

Microincision surgery in combined vitreoretinal and cataract procedures

Werschnik C., Wilhelm F.
Eye Department of HELIOS Clinics Schwerin

In vitreoretinal as well as in cataract surgery smaller and smaller incisions are aimed. After 25 gauge-vitrectomy itself has not asserted due to instrument instabilities, the use of 23 gauge-vitrectomy increases, especially in indications where no silicone oil endotamponade is planned. Since the development of suitable foldable lenses we have had the possibility to do bimanual phacoemulsification via paracentesis of 1,5-1,7 mms to minimize the postsurgical astigmatism. It is obvious to combine these both procedures. For an experienced surgeon it is easy to change on this combined method. We have introduced this technology in our department and collected very good experience. There is not any more the danger of tunnel opening by indentation during vitrectomy and one can renounce the suture. The slightly increased costs and extended vitrectomy time due to smaller instruments, the danger of backflash of silicone oil as well as the raised risk of hypotony and endophthalmitis are disadvantageous. All together it concerns an effective, less traumatic and safe combination of microincision technologies for different vitreoretinal indications. The operated eyes show a quicker post surgical rehabilitation and the patient's comfort considerably improves on account of the missing sutures. Larger prospective comparable studies between 23 and 20 gauge-vitrectomy and between conventional and bimanual phacoemulsification are necessary. Will this combination of microsurgical technologies become the new standard procedure?

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