Two in One
Phacovitrectomy may be a sensible option that makes cents
Arsham Sheybani and Rajendra S. Apte |
Cataract surgery is the most commonly performed operating room procedure in elderly patients in the US, and it’s estimated that over 3.5 million cataract operations are performed each year in the country (1). Many pars plana vitrectomies (PPVs) are also performed in the US each year – and by tabulating Medicare utilization data, we identified that close to 23,000 vitrectomies were performed in 2014 (2). Our point? The potential for an increase in concomitant retinal and lens-related disorders is only going to escalate in this aging population.
The overwhelming majority of phakic patients who undergo vitrectomy develop visually significant cataracts (with the risk increasing with age) whether or not gas tamponades are used (3)(4) – yet this has not translated into the adoption of phacovitrectomy by vitreoretinal surgeons in the US. By comparison, glaucoma surgeons commonly perform cataract surgery combined with trabeculectomy or tube shunt surgery (5), and we suspect that the familiarity with cataract surgery by the glaucoma specialist has fueled this trend.
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