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Shin, Kyung Sup, MD*,†; Lim, Hyung Bin, MD*,‡; Shin, Yong Il, MD*; Lee, Seong Eun, MD*; Jo, Young Joon, MD, PhD*; Kim, Jung Yeul, MD, PhD*

doi: 10.1097/IAE.0000000000002178
Original Study: PDF Only

Purpose: To investigate the efficacy and safety of a primary core vitrectomy technique for combined phacovitrectomy in eyes showing a poor red reflex because of dense vitreous hemorrhage before cataract surgery.

Methods: A total of 156 eyes from 156 patients, who underwent combined phacovitrectomy because of cataract and dense vitreous hemorrhage, and who were followed up for at least 6 months were included. The patients were divided into a primary phacoemulsification group (Group A, 80 eyes) who underwent phacoemulsification first followed by total vitrectomy and a primary vitrectomy group (Group B, 76 eyes) who underwent core vitrectomy first followed by cataract surgery and followed by total vitrectomy. A conventional 23-gauge combined phacovitrectomy was performed in all patients. The operation time, including the total continuous curvilinear capsulorhexis time and total cataract surgery time, and the incidence of surgery-related complications were evaluated in the two groups.

Results: Diabetic retinopathy was the most common cause for vitreous hemorrhage in both groups (Group A: 51 eyes; Group B: 39 eyes). The total continuous curvilinear capsulorhexis time (P = 0.001) and total cataract surgery time (P = 0.036) were significantly shorter in Group B than in Group A. Among the complications, radial tears occurred more frequently in Group A than Group B, but these differences were not statistically significant (P = 0.211). Pupil size reduction during cataract surgery was greater in Group B than in Group A (P = 0.034). There were no significant differences in posterior capsular ruptures or posterior capsular opacities between the two groups. Other postoperative complications were not observed in either group until 6 months after surgery.

Conclusion: Primary core vitrectomy combined with phacovitrectomy of patients who had dense vitreous hemorrhage helped to obtain a good red reflex and enabled surgeons to perform successful cataract surgery. In addition, primary core vitrectomy was an easy and safe technique, which reduced the surgery time and surgery-related complications. This surgical technique would, therefore, be helpful to vitreoretinal surgeons.

Primary core vitrectomy in combined phacovitrectomy is a very easy and useful technique. The surgeon can obtain an intrinsic red reflex and can perform cataract surgery faster, with fewer complications, than when performing cataract surgery under a poor red reflex.

*Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea;

Chang Eye Clinic, Daejeon, Republic of Korea; and

Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Republic of Korea.

Reprint requests: Jung Yeul Kim, MD, PhD, Department of Ophthalmology, Chungnam National University Hospital, #640 Daesa-dong, Jung-gu, Daejeon, 35015, Republic of Korea; e-mail:

This work was supported by research fund of Chungnam National University.

K. S. Shin and H. B. Lim contributed equally as first authors.

Design and conduct of the study (K.S.S., H.B.L., and J.Y.K.); collection of data (K.S.S., Y.I.S., and S.E.L.); analyses and interpretation of the data (K.S.S., H.B.L., Y.I.S., and J.Y.K.); writing the manuscript (K.S.S., H.B.L., and J.Y.K.); critical revision of the manuscript (K.S.S., H.B.L., and J.Y.K.); and final approval of the manuscript (K.S.S., H.B.L., Y.I.S., S.E.L., Y.J.J., and J.Y.K.).

© 2019 by Ophthalmic Communications Society, Inc.