Eyeworld Daily News

6 | EYEWORLD DAILY NEWS | JULY 25, 2021 ASCRS ANNUAL MEETING DAILY NEWS ASCRS EXECUTIVE DIRECTOR Steve Speares PUBLISHER Don Bell MANAGING DIRECTOR Stacy Jablonski EDITORIAL CO-DIRECTORS Ellen Stodola Liz Hillman GRAPHIC DESIGNERS Susan Steury Katherine Beutner PRODUCTION MANAGER Cathy Stern SALES, SPONSORSHIPS, AND CORPORATE PROGRAMS Jessica Donohoe Joe Dooley Cathy Stern Phaco-vitrectomy tips shared in symposium I n "Retina Essentials for the Anterior Segment Surgeon," Christina Weng, MD, MBA, discussed combined cataract and vitreoretinal surgery. Dr. Weng said that this is a shared decision-making process with the patient, with the three options being: do nothing, do sequential surgery, or do combination sur- gery. Dr. Weng shared benefits and drawbacks of phaco-vitrectomy. Advantages include: It spares the patient an additional sur- gery; it can sometimes improve visualization for the retina sur- geon; there is greater eventual postop visual improvement, and it mitigates floaters that often get worse post-phaco; there is a unidirectional visual improve- ment trajectory rather than a visual roller coaster post-PPV; it is societally more cost effective; and the cataract surgeon avoids a higher complication rate of phaco in post-vitrectomy eyes. Disadvantages include: There is a slower recovery process with more postop inflammation; it can worsen visualization for either surgeon; it violates the anterior-posterior barrier and can lead to IOL displacement if a tamponade is used; the refractive outcomes is less predictable; there is reduced reimbursement for one co-surgeon; and it can be logisti- cally difficult. Preoperatively, Dr. Weng said it's important to prepare the patient for a possibly lon- ger recovery and realistic visual outcomes. Consents should be done by each surgeon. Dr. Weng said to be mindful of IOL selec- tion, adding that monofocal, hydrophobic, acrylic IOLs are the safest bet when concurrent retinal pathology exists. Axial length measurements should consider details such as a patient having silicone oil in the eye. She said it's important to carefully plan pre- operatively with your co-surgeon and discuss the order of proce- dure and incision placement. Intraoperatively, Dr. Weng said to use minimal retrobulbar block in order to avoid excessive posterior pressure. She said not to hesitate to stain the anteri- or capsule, as red reflex may be diminished. Keep the cap- sulorhexis diameter smaller to counteract posterior forces, and avoid hydrating corneal wounds, minimize phaco energy, and work away from the endothelium to preserve corneal clarity. Dr. Weng suggested minimizing iris manip- ulation to maintain dilation for the vitrectomy portion. Suture all corneal and scleral wounds in combined cases and consid- er pre-placement of an infusion line at the start of the procedure. Check the positioning of the IOL before closing after vitrectomy, and consider injection of a steroid into the subconjunctival/sub-Ten- on's space to temper postoperative inflammation. Postoperatively, Dr. Weng noted that if the patient is posi- tioned face-down, you may see a small amount of hemorrhage along the posterior surface of the IOL or in the AC. The IOL optic may be bowed anteriorly or tilted in the initial postop period if a gas tamponade was used. Defer post- op instructions to one surgeon to avoid confusion, and try to align or alternate postop visits. Phaco-vitrectomy can help avoid an outcome that falls short of patient expectations, Dr. Weng said, and with modifications, it's easy to optimize the outcomes of both surgeries. Editors' note: Dr. Weng has fi- nancial interests with various ophthalmic companies.

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