26.2 Pars Plana Lensectomy
26.3 Intraocular Lens Explantation
26.4 Secondary Intraocular Lens Insertion Clinical Scenarios & Clinical Decision Making
26.5 Sulcus Intraocular Lens
26.6 Anterior Chamber Intraocular Lens
26.7 Iris Fixated Intraocular Lenses
26.8.1 Scleral Sutured Intraocular Lens – Traditional 2 Point Fixation
26.8.2 Scleral Sutured Posterior Chamber Intraocular Lens 4 Point Fixation
26.8.3 Scleral Sutured Posterior Chamber Intraocular Lens – “Hoffman” Corneoscleral Pockets
26.8.4 Alternate Technique to Rescue a Dislocated IOL – Triangular Scleral Flap, Sutured IOL Technique
26.8.5 Suturing Without Exchanging the Intraocular Lens
26.9 Sutureless Scleral Fixation of an Intraocular Lens
Phacovitrectomy may be useful in the following scenarios:
Advantages include faster visual rehabilitation, easier access for vitreous base shaving, and the potential for better visualization. Potential disadvantages include difficulties in performing accurate pre-operative lens calculations, increased post-operative inflammation, longer operative time, suboptimal refractive outcomes (typically myopic shifts, hyperopic if not using an endotamponade), corneal edema precluding operative visualization, post-operative hypotony, higher rates of post-operative endophthalmitis, and the risk for lens dislocation and/or malposition with use of a tamponade.
In general it is easiest to remove the cataract prior to performing the vitrectomy. This allows for the clearest visualization of the fundus. However, some surgeons do prefer to remove silicone oil prior to performing phacoemulsification since the oil can increase posterior pressure on the crystalline lens, making phacoemulsification more difficult.
Valved trocars can be placed prior to beginning the phacoemulsification procedure to allow for easier trocar insertion prior to clear corneal incision. The infusion in the pars plana may be visualized but should not be turned on until completion of the phacoemulsification procedure.
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Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.