Where anterior segment and posterior segment surgery meet

THIS year’s EURETINA meeting included a joint EURETINA/ESCRS symposium on where anterior segment and posterior segment surgery meet. Commencing the session, co-chairman, Gisbert Richard MD, University Medical Centre Hamburg-Eppendorf, described a combined surgery procedure for cataract patients who require pars plana vitrectomy (PPV) for such indications as epiretinal membranes, macular holes and diabetic retinopathy. He noted that PPV can induce cataract and a progressive myopisation in a high proportion of patients. Combining PPV with cataract surgery can eliminate those problems. However, the two procedures have contradictory requirements. PPV requires a closed system that will tolerate an increased IOP whereas cataract surgery requires opening of the eye, he said. To meet the conflicting requirements of the PPV and cataract surgery, Dr Richard has adopted a combined approach that employs a long corneoscleral tunnel.The procedure commences with the fixation of two eye muscles and the precise creation of a corneoscleral tunnel at least 3.5mm in length through which both PPV and cataract extraction are performed. “A combined approach using a corneoscleral tunnel tolerates the pressure increase while at the same time allowing an opening large enough for cataract surgery,” he said.