![]() “If the capsulorhexis is too big, it may be best to wait at least a month to allow the capsular bag to “shrink-wrap” down to hold the lens firmly in place,” he explains.ĭr. I almost always have the cataract surgeon do his surgery first, and in cases of borderline macular disease, patients will be happy with their vision after cataract surgery alone, and not need vitrectomy.”Īccording to Uday Devgan, MD, who is in practice in Los Angeles, another critical factor is making sure the capsulorhexis overlaps the optic for a full 360 degrees. I also find that a combined surgery is sometimes unnecessary. They are either taking up your OR time by doing a cataract or you’re taking up their OR time by doing a retina case. “I also think it’s inefficient to perform a combined procedure with another surgeon. ![]() “My biggest referring cataract group operates at a different surgery center than I do, so even if I wanted to do a combined case with one of their surgeons, I couldn’t,” he says. The patient was already going to have a vitrectomy that day, so then the retina specialist just stepped in a little earlier, removed the remaining lens and then did the retina procedure.”Ĭombined procedures also have some downsides, one of which is scheduling, says Tom Stone, MD, who is in practice in Louisville, Kentucky. “For example, during my residency, I was performing a cataract procedure first, and then half the lens fell to the back of the eye. “In that situation, if a patient has a retinal problem and has already had intravitreal injections or some sort of vitrectomy in the past, it does increase the risk of a retained lens fragment or a posterior capsular rupture during cataract surgery,” he says. I find that most patients are more than happy to have a two-in-one surgery to optimize their visual acuity, especially in a cataract surgery era where patients’ expectations are so high.”Īccording to Andrew Kao, MD, who is in practice in Bakersfield, California, one benefit of a combined procedure is potentially less cost to the health system overall. “While there are some risks with combined surgery, both modern-day cataract and retina surgery are very safe. “If you stage the surgery, there’s always the risk that patients will have an outcome that falls short of their expectations,” she says. Weng believes that concurrent management of anterior and posterior segment pathology can often help patients achieve their best visual outcomes sooner. ![]() ![]() In these scenarios, it can be challenging to discern which symptoms are from the cataract and which are from the epiretinal membrane, but if both are likely contributing to the patient’s visual impairment, combined surgery is a terrific option.”ĭr. “However, the more common situation is when there are two pathologies that can be addressed electively, such as an epiretinal membrane and a cataract. “For example, I can’t fix a retinal detachment if a dense cataract is obscuring the view,” she notes. The combined procedure, phacovitrectomy, provides several advantages for patients and retina specialists.Īccording to Christina Weng, MD, MBA, a retina specialist on faculty at Baylor College of Medicine in Houston, there are two categories of situations in which surgeons might consider a combined approach. Wh en patients need both cataract and retina surgery, the procedures can be performed in combination or using a staged approach. ![]()
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