Combined Extracapsular Cataract Extraction, Posterior Chamber Intraocular Lens Implantation, and Pars Plana Vitrectomy

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Abstract
The surgical management of coexisting cataract and vitreoretinal disease has been controversial, particularly for eyes with a history of proliferative diabetic retinopathy (PDR) or chronic uveitis. We retrospectively studied the results of combined extracapsular cataract extraction (ECCE), posterior chamber intraocular lens (PC-IOL) implantation, and pars plana vitrectomy in 20 eyes of 16 patients. The indications for combined vitrectomy included dense, nonclearing vitreous hemorrhage attributed to PDR in 10 eyes, age-related macular degeneration in 2, and trauma in 1. The remaining 7 eyes had pars plana vitrectomy to remove inflammatory vitreous cell and debris associated with chronic uveitis. Follow up ranged from 4 to 32 months (average, 17.4 months). Visual acuity improved in 19 eyes (95%)--to 20/100 or better in 12 (60%). The improvement ranged from 1 to 13 Snellen lines (average, 4.9 lines). Postoperative visual acuity improvement averaged 7.5 Snellen lines for eyes with chronic uveitis, 7.0 lines for those with age-related macular degeneration, and 3.3 lines for those with a history of PDR. Postoperative visual acuity was less than 20/100 in 8 eyes (40%). In most cases, these latter results were attributed to macular changes associated with the underlying ocular disease. Our results confirm previous studies that have shown that combined ECCE/PC-IOL implantation and pars plana vitrectomy is a well-tolerated surgical procedure for diabetics, which can provide clear anterior and posterior segment media. In addition, our results suggest that this combined procedure can be useful in restoring vision in certain eyes with uveitis in the short-term postoperative period.