Doube optimization for improved solutions
There are several reasons in support of combining anterior and posterior segment surgery. For instance, eyes presenting for cataract surgery may also have vitreoretinal problems, from vitreous degeneration to epiretinal membrane and macular hole, from diabetic retinopathy to retinal vein occlusion requiring laser treatment, and up to retinal detachment.
Recent research found epiretinal membrane in 7% of eyes presenting for cataract surgery.1 However, eyes with retinal problems can also develop cataract, both during surgery in the case of lens touch, or after surgery especially in the case of posterior tamponade by silicone oil.
The removal of a cataract in the absence of vitreous faces zonular weakness, anterior chamber instability, zonula relaxation, and the possible development of plaques especially on the posterior capsulae. In contrast, simultaneous cataract removal and posterior vitrectomy allows the surgeon to complete the vitrectomy with full shaving of the vitreous base, and to obtain better posterior tamponade with less chance of PVR recurrence. In addition, both the patient and the surgeon benefit from the single procedure for cost reason, and for the single infection risk.
MICS just before posterior surgery
The modern approach to combined anterior and posterior segment surgery includes microincision cataract surgery (MICS) and transconjunctival sutureless vitrectomy (TSV). New machines are being developed, specifically designed to optimize both types of surgery.