Eyeworld

FALL 2026 | EYEWORLD | 43 C REWIND. REFRESH. REFINE. by Liz Hillman Editorial Co-Director About the physicians Anthony Mai, MD DLV Vision Oxnard, California Michael Patterson, DO The Eye Centers Crossville, Tennessee Christina Y. Weng, MD, MBA Alice R. McPherson Retina Research Foundation Chair in Ophthalmology Professor of Ophthalmology Baylor College of Medicine Houston, Texas during what was originally a routine cataract surgery. Dr. Mai said there are many times such a combined procedure is needed, and in those cases "it's great to have one machine instead of having to go to a different machine." Dr. Mai has experience using a phacovitrectomy ma- chine, though he only used its anterior segment capabilities. At the time, the practice he worked at was one of the first to have the UNITY Vitreoretinal Cataract System (VCS, Alcon). "We did do anterior vitrectomy, but that's not like a full switch over to the posterior seg- ment side of the machine. I haven't been in a place where they switched back and forth," Dr. Mai said. For anterior vitrectomies, he said the cut rate on this machine was higher than older, phaco-only models. "It's also smaller … so the maneuverability is better. The speed at which the vitrector cuts is faster. Overall, it's better for anterior vitrectomy because it's working more toward how it feels for the posterior segment." Dr. Weng said that while she's not speaking for all platforms, she finds many phaco-only machines she used in the past did not offer an optimized cut rate or fluidics for anterior vitrectomy equivalent to that of a retina plat- form. "The notion that these features are not as important because it is 'just the anterior vitre- ous' is misguided," Dr. Weng said, explaining why. "The anterior vitreous is not only closer to the vitreous base where retinal tears often occur T here are now several all-in-one phacovitrectomy machines on the market, but is one appropriate at your surgery center? These platforms seek to streamline workflows, reduce equipment footprint, and improve efficiency when anterior and posterior segment surgery intersect. But for many surgery centers—partic- ularly those without retina coverage, focused on the anterior segment—the decision to invest in a combined system depends heavily on case mix, staffing patterns, and how often vitreous management is truly needed in the cataract OR. "The reason we are seeing more and more combined phacovitrectomy systems emerging is related to the dynamics within the ophthal- mology space," said Christina Y. Weng, MD, MBA. "There is a huge need for ophthalmic care given the aging population. Patient expectations are at an all-time high. Reimbursement levels continue to wane. And there are more surgical technologies available than ever before. So, it is no surprise that there is a growing focus on delivering the highest quality of care in the most efficient way possible. In the OR of 2026, every minute and every square foot represents an opportunity to maximize productivity, and these next-generation phacovitrectomy systems can help streamline workflows in our ASCs." Anthony Mai, MD, said the combined machines make perfect sense for ASCs or aca- demic centers that support both anterior and posterior segment surgeons. However, he noted, many private practice settings in the U.S. focus solely on the anterior segment or the posterior segment, making an often more expensive pha- covitrectomy machine seemingly superfluous. However, some retina surgeons will do cataract surgery, which could make these combo ma- chines advantageous, Dr. Mai said. "If you have both specialties going on in your center, these machines can be fairly useful —one footprint," Dr. Mai said. "If you don't have both specialties, then ... you might have a piece of equipment or at least a feature that's not being used all that often." The biggest advantage of the combina- tion machines is in the name—if a surgeon is heading into a case for a planned cataract and retina procedure or if the need for one arises All-in-one phacovitrectomy systems: when are they worth it? continued on page 44 Patient with cataract and tractional retinal detachment undergoes combined phacovitrectomy Source: Christina Y. Weng, MD, MBA

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