What is a combined surgery?

When two different surgeries are done on an eye at the same sitting  they are commonly referred to as combined surgery.  For example cataract and vitrectomy surgery, cataract and silicone oil removal surgeries are very frequently done surgeries at Neoretina, a tertiary care advanced hospital for complex eye conditions.

Cataract and trabeculectomy surgery ( glaucoma filtration surgery) is also another example of combined surgery.

Cataract and trabeculectomy surgery

Figure 1. Significant cataract

Why is it necessary to do combined surgery?

When a patient has a significant cataract and retinal disease that requires vitrectomy surgery it is not possible to do a vitrectomy surgery without removing the cataract. Cataract is a clouding of the natural lens and its presence obscures the view of the inside of the eye for the operating surgeon necessitating its removal.

Sometimes when there is minimal or early cataract, a retina surgeon can choose to go ahead with vitrectomy without handling the cataract depending on the type of retinal disease being treated. 

Retina surgery

Figure 2. Retina surgery

What are the alternatives to a combined surgery?

One could do a sequential surgery.  First, the cataract needs to be operated by an anterior segment surgeon and subsequently, after one or two weeks a retina specialist could do a vitrectomy surgery.

In the presence of significant cataract, it is not possible to do a vitrectomy surgery first.

Can one surgeon do both cataract and vitrectomy surgery?  

No. Generally by training and practice they are two different sub-specialities of ophthalmology. Doctors who are proficient in vitrectomy surgery do not regularly do cataract surgery. They are best done by two surgeons combining their skills on their respective specialities for the optimal outcome.

What are the advantages of combined surgery to the patient?

It’s convenient for the patient to undergo surgeries in one setting in terms of postoperative rest and medications which are not repeated. It also decreases the risk of infections as well as any adverse events as the surgeries are combined. Overall patient stay in the operation theatre and in the hospital is reduced. Reduced stay in the hospital is especially important during the current Covid19 pandemic.

It is also economical for the patient as the cost of combined surgeries is always less than the  two performed separately.

Is it always possible to implant an intraocular lens (IOL) during the combined surgeries?

Normally after removal of the cataract, an artificial lens called an intraocular lens (IOL) is implanted into the eye. In some exceptionally challenging situations during surgery like subluxation of cataract or poor capsular support surgeon may choose not to implant IOL and then go ahead and complete the vitrectomy surgery.  In that scenario sometimes we can implant the IOL at a secondary surgery when the retinal condition is stable.