There are advantages and disadvantages to combining cataract removal (and typically IOL implantation) with the vitrectomy (see Table 4.2). This chapter is primarily dedicated to the technical issues of combined surgery. The decision-making process regarding the type of lens removal technique is shown in Fig. 38.1.

The question whether a clear lens needs to be removed in the eye that has no (or only weak) accommodation has no straightforward answer. The surgeon must not hesitate to remove the lens if its presence would interfere with the success of the vitrectomy; otherwise, he should discuss it with the patient (see Chap. 5), although other issues are also at play (see Sect. 4.6).

Pearl

The condition of the retina and the ciliary body determines the operation’s success, not whether the lens was preserved.

38.1Phacoemulsification

The operation is done similar to how it is normally performed; only a few unique suggestions are made here. The cataract surgery precedes the vitrectomy unless special circumstances exist.

•Place the cannula for the infusion first1; whether the two additional cannulas are also inserted now or later is up to you. The infusion line need not be connected until the PPV commences.

1 The eye becomes soft by the time the procedure is completed, making the cannula insertion difficult.

F. Kuhn, Vitreoretinal Surgery: Strategies and Tactics,

DOI 10.1007/978-3-319-19479-0_38