One anaesthetic, one recovery
Two operations become one visit to theatre, one anaesthetic and one period of drops and reviews, instead of two.
Combined cataract and
retinal surgery
Cataract surgery and vitrectomy performed in one operation, why the two are sometimes done together, and when staging them is the better plan.
What combined surgery is.
Combined surgery means cataract surgery and vitrectomy performed in one sitting, in an eye that needs both.
Vitrectomy is retinal surgery: the clear gel that fills the back of the eye, the vitreous, is removed through small openings in the wall of the eye so the retina can be reached and treated. Cataract surgery removes the cloudy natural lens and replaces it with a clear artificial one. When an eye needs both, the two can often be done as a single operation. It is also called phacovitrectomy, from phacoemulsification, the ultrasound technique that removes the cataract, and vitrectomy.
Because Dr Chen operates on both the cataract and the retina, an eye that needs both can be planned as one operation rather than handed between two surgeons.
What cataract surgery involves → IOL exchange and complex cataract →In brief
- Cataract surgery and vitrectomy in one operation
- Also called phacovitrectomy
- Considered when an eye needs both
- One anaesthetic and one recovery period
- The lens choice is discussed beforehand
- Not right for every eye; sometimes staging is better
The reasoning
Why the two are sometimes done together.
The cataract often needs doing anyway
A cataract commonly progresses after vitrectomy, so an eye that already has some lens clouding may well need cataract surgery within a year or two of the retinal operation.
The lens can be in the way
A cataract makes the back of the eye harder to see. Removing it can give a clearer view of the retina during the retinal part of the operation, and clearer examination and imaging afterwards.
General information. Whether combining suits a particular eye is decided at the consultation.
On the day
What the operation involves.
The cataract step comes first, then the retinal step, in the same sitting.
The cataract is removed by phacoemulsification and an artificial lens is placed in the capsule, as in ordinary cataract surgery. The retinal part follows: fine instruments are passed through small openings in the wall of the eye, the vitreous gel is removed, and the retinal problem is treated according to the diagnosis, whether that is a membrane peeled, a macular hole addressed or a detachment repaired. A gas bubble or another tamponade may be placed at the end, in which case posturing and travel advice follow the retinal part rather than the cataract.
The lens choice is settled beforehand, because the retinal condition affects it. What the macula can be expected to deliver, whether a gas bubble is planned, and whether further retinal treatment may be needed all bear on which lens is sensible for that eye. Some designs that suit an otherwise healthy eye are less appropriate when the macula is affected.
Intraocular lens choices → Femtosecond laser cataract surgery →Planned before the day
- Which retinal procedure is needed, and why
- The lens power and design, in the light of the retinal condition
- Whether a gas bubble or another tamponade is likely
- Posturing, travel and time off, which follow the retinal part
- Whether combining or staging is the better plan for that eye
Background
Combining the laser with retinal surgery.
Dr Chen was the first surgeon in the world to perform femtosecond laser cataract surgery combined with retinal surgery.
The technique is described in a peer-reviewed paper he co-authored.
Bali SJ, Hodge C, Chen S, Sutton G. Femtosecond laser assisted cataract surgery in phacovitrectomy. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2012;250(10):1549–1551. Read the publication on PubMed →. DOI: 10.1007/s00417-012-2080-y.
Read the research paper →For orientation
- Femtosecond laser cataract surgery is set out on its own page
- Combining it with retinal surgery is one variation of the operation described here
- A laser step is not needed for combined surgery, and is not used in every eye
Honest limits
When combining is not the right plan.
Not every eye is suited to having the two operations together.
Sometimes the retinal problem needs attention now and the cataract does not. Sometimes the retinal condition makes the lens calculation less reliable, and the sounder plan is to treat the retina first and choose the lens afterwards. Sometimes the eye, the state of the lens or the view during surgery makes staging the two operations the better course.
Recovery reflects the retinal condition rather than the cataract. Where cataract surgery alone usually settles over a few weeks, the pace after combined surgery follows the retinal part: the posturing, the gas bubble if one is used, and how the macula recovers. What vision can be expected afterwards depends on the state of the retina, and is discussed before anything is booked.
Retina care →What to weigh
- A longer operation than cataract surgery alone
- The risks of both operations apply, and are explained before surgery
- The final focus is less predictable than in routine cataract surgery
- Recovery follows the retinal condition, not the cataract
- Staging the two operations is sometimes the better plan
General information, not a guarantee of outcome.
Questions to ask
Useful questions for the consultation.
- Does my eye need both operations, and does it need them now?
- Would you combine them or stage them, and why?
- How does my retinal condition affect the lens choice?
- Will a gas bubble be used, and what would that mean for posturing and travel?
- What can I reasonably expect my vision to do afterwards?
- What is the recovery likely to look like, week by week?
Bring these, and anything else on your mind. Write the answers down, or bring someone who can.
Common questions
Straight answers, without replacing a consultation.
Is this one operation or two?
One. The cataract step and the retinal step are performed in the same sitting, under one anaesthetic.
What does phacovitrectomy mean?
It joins phacoemulsification, the ultrasound technique that removes a cataract, with vitrectomy, the removal of the vitreous gel so the retina can be reached and treated.
Why not treat the retina first and the cataract later?
Sometimes that is exactly the plan. Staging is chosen when the cataract is mild, when the lens calculation would be more reliable afterwards, or when the eye is better served by two shorter operations.
Will I still need cataract surgery later?
Not if the cataract is removed as part of the combined operation. A cataract commonly progresses after vitrectomy, which is one of the reasons the two are sometimes done together.
Does the lens choice change?
It can. The retinal condition is part of the decision, and some designs that suit an otherwise healthy eye are less appropriate when the macula is affected.
How long is the recovery?
It follows the retinal part of the operation rather than the cataract, including any posturing if a gas bubble is used. The expected pace is explained beforehand.
Ready when you are.
Appointments and enquiries through Vision Eye Institute, Chatswood.
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