Publicação
Pars Plana Vitrectomy for Treatment of Complications During Phacoemulsification: Indications, Timing and Technique
| Resumo: | Phacoemulsification is a procedure with a very low complication rate. Posterior capsule rupture with displacement of fragments is one of the most common complications. However, since it is the most performed ophthalmic surgery worldwide, the prevalence of these complications is high, with potentially vision threatening consequences. Pars plana vitrectomy (PPV) is the gold-standard surgery for removing fragments. The indications for PPV, the timing between phaco-emulsification and PPV, and the best PPV technique to be used are subjects of great controversy. Our aim was to review the previous studies assessing these controversial subjects, aiming a better and easier decision-making and an optimization of the use of PPV for the management of post-phacoemuslification complications. Search was conducted in MEDLINE using the MeSH keywords “phacoemulsification” and “vitrectomy”, filtered from April 2011 to April 2021, resulting in 394 results of which 23 were related to the purpose of this review. The indications to perform PPV over conservative management, the timing after phacoemulsi- fication, and the PPV technique to be used are multifactorial decisions which depend on the availability of both a surgical facility and a vitreoretinal surgeon. Decision-making is also based on the suspected degree of ocular complications, physician ́s discretion, and surgeon’s experience in a specific technique. Lens fragments size and density should be reported to help decide whether or not to perform PPV. There is a tendency for better outcomes when PPV is performed in an early setting (if not at the same surgical time as phaco, the first 3 days should be avoided), and small- incision 23- and 25-gauge sutureless PPV is advantageous over 20-gauge, especially regarding glaucoma patients. There is a great amount of bias and more studies with larger sample-size are needed to draw more and reliable conclusions. |
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| Autores principais: | Neves da Cruz, Carlos Manuel |
| Outros Autores: | Sousa, Keissy; Calvão-Santos, Gil; Pinto, Christophe |
| Assunto: | Artigos de Revisão |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Sociedade Portuguesa de Oftalmologia |
| Idioma: | inglês |
| Origem: | Revista Sociedade Portuguesa de Oftalmologia |
| Resumo: | Phacoemulsification is a procedure with a very low complication rate. Posterior capsule rupture with displacement of fragments is one of the most common complications. However, since it is the most performed ophthalmic surgery worldwide, the prevalence of these complications is high, with potentially vision threatening consequences. Pars plana vitrectomy (PPV) is the gold-standard surgery for removing fragments. The indications for PPV, the timing between phaco-emulsification and PPV, and the best PPV technique to be used are subjects of great controversy. Our aim was to review the previous studies assessing these controversial subjects, aiming a better and easier decision-making and an optimization of the use of PPV for the management of post-phacoemuslification complications. Search was conducted in MEDLINE using the MeSH keywords “phacoemulsification” and “vitrectomy”, filtered from April 2011 to April 2021, resulting in 394 results of which 23 were related to the purpose of this review. The indications to perform PPV over conservative management, the timing after phacoemulsi- fication, and the PPV technique to be used are multifactorial decisions which depend on the availability of both a surgical facility and a vitreoretinal surgeon. Decision-making is also based on the suspected degree of ocular complications, physician ́s discretion, and surgeon’s experience in a specific technique. Lens fragments size and density should be reported to help decide whether or not to perform PPV. There is a tendency for better outcomes when PPV is performed in an early setting (if not at the same surgical time as phaco, the first 3 days should be avoided), and small- incision 23- and 25-gauge sutureless PPV is advantageous over 20-gauge, especially regarding glaucoma patients. There is a great amount of bias and more studies with larger sample-size are needed to draw more and reliable conclusions. |
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