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Combined surgery in Proliferative Diabetic retinopathy. Personal point of view.


Carlos Mateo

Barcelona, Spain

Diabetes increases the cataract incidence in an earlier age.When dealing with a patient with Proliferative diabetic retinopathy and cataract we have to chose the surgical procedure of choice to manage the cataract. The main problems in the management of the cataract in combined surgery of proliferative diabetic retinopathy are: 1. - bad midriasis; 2. - Presence of iris neovessels 3. - prone to develop intraoperative myosis that precludes optimal visualisation . Limbal approach Phacoemulsification is the most extended technique to manage this patients. Postoperative complications are: 1. - Constant Opacification of the capsulorhexis;2. - Opacification of the bag´s equatorial area. 3. - Posterior sinequia to the capsulorhexis and the rest of the anterior capsule.
To avoid this problems we always manage the cataract performing lensectomy, leaving in place the anterior capsule that is polished to the equator obtaining the best visualisation from the posterior pole to the far periphery. At the end of the proliferative tissue delamination we decide if an intraocular lens can be useful depending of the retinal status.This has some advantages :1. - The anterior chamber is not open untill the end of the operation for what there are not changes in the pupillary diameter 2. - No corneal fods are observed 3. - No lposterior sinequia to the capsulorhexis because there is not need to perform it 4. - opacity of the anterior capsule takes a long time to appear if it is polished conveniently