Phacovitrectomy

Phacovitrectomy is a combined intraocular surgery that includes phacoemulsification cataract extraction with intraocular lens implantation and pars plana vitrectomy performed in a single operative session. This approach is chosen when there are both significant cataract and vitreoretinal disorders, allowing simultaneous treatment of the lens opacity and the retinal or vitreous disease to improve visualization and access to the retina.

Indications for phacovitrectomy include coexisting cataract with vitreoretinal pathology such as macular hole, epiretinal membrane, rhegmatogenous retinal detachment, vitreous hemorrhage from proliferative diabetic retinopathy, and other vitreoretinal disorders where lens opacity would hinder retina surgery. It may also be used when cataract progression is anticipated after vitrectomy.

Procedure overview typically begins with cataract removal and intraocular lens implantation, followed by pars plana vitrectomy. Surgeons may address the vitreoretinal pathology, perform membrane peeling if needed, and use fluid–air exchange with tamponade agents such as gas or silicone oil as indicated. The intraocular lens is usually placed in the natural capsule if feasible; alternatives include sulcus placement or scleral-fixated lenses if capsule support is inadequate.

Benefits of the combined approach include a single anesthesia event, shorter overall recovery, improved intraoperative visualization, and the avoidance of a later combined retina and cataract surgery. Limitations include longer surgical time, potentially higher inflammation, and the possible need for different tamponade strategies or alternate IOL fixation depending on intraocular conditions.

Alternatives include sequential surgery, with cataract extraction performed first or after vitrectomy, or performing vitrectomy alone if the lens is not significantly occluding the view. Outcomes vary with the underlying retinal condition and patient factors.