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I carry out all the steps of phacoemulsification first then proceed to pars plana vitrectomy (PPV).

Surgical steps of my combined phacoemulsification PPV technique involve:

1. Clear corneal temporal incisions,

2. Capsulorrhexis,

3. Phacoemulsification,

4. Irrigation/ aspiration,

5. In bag IOL implantation,

6. A single 10/0 nylon suture,

7. Deflation of the capsular bag by removing all the ophthalmic viscoelastic device (OVD) then injecting OVD again in the anterior chamber only

8. Insertion of the first toracar and clipping the infusion cannula while keeping the infusion off until the other 2 trocars are inserted

9. Vitrectomy surgery is then commenced by doing some anterior vitrectomy before inserting the BIOM 1

0. PPV and other required steps are then performed as planned.

Routinely, I will carry out phacoemulsification while sitting upper temporally then move superiorly to perform PPV. In some cases where the cataract is soft, I will perform the phacoemulsification through a temporal incision while seated superiorly.

Advantages:

Minimal shift in my sitting position and the microscope position. Additionally the technique described decreases the likelihood of inadvertently tearing the posterior capsule during vitrectomy owing to that the capsular bag has been deflated from the OVD and the capsule is almost lying flat against the back surface of the IOL implant.