Combined Surgery

This chapter reviews the advantages and disadvantages of phacovitrectomy, a combined surgical approach integrating pars plana vitrectomy (PPV), phacoemulsification, and intraocular lens (IOL) implantation. As phacovitrectomy has become a standard intervention for patients with concurrent vitreoretinal disease and cataracts, it offers distinct clinical benefits, including a single anesthetic session, accelerated visual rehabilitation, and enhanced economic efficiency. While functional outcomes and complication rates are generally comparable to sequential surgery, the procedure is also associated with a slight higher incidence of postoperative inflammation and minor refractive errors, such as a mild myopic shift. This chapter details the evolution of the technique, facilitated by advancements in microincision vitrectomy sy 23, 25, and 27G) and wide-field visualization-specific applications in managing several ocular pathologies such as proliferative diabetic retinopathy, macular holes, epimacular membranes, and complex retinal detachments. Ultimately, the procedure requires an experienced surgeon to navigate intraoperative challenges, such as the loss of the red reflex and the maintenance of anterior chamber stability during peripheral vitreous shaving.