PURPOSE: To assess the efficacy and safety of bimanual microphacoemulsification combined with vitrectomy in eyes with clinically evident cataract and vitreoretinal pathology. SETTING: Institute of Ophthalmology of the University of Modena and Reggio Emilia, Modena, Italy. METHODS: This prospective case series comprised 19 consecutive patients with clinically significant cataract who were scheduled for vitrectomy. Bimanual microphacoemulsification was performed, and an Acri.Smart 46 S hydrophobic acrylic intraocular lens (IOL) with a 6.0 mm optic (Acri.Tec, Inc.) was implanted in the capsular bag. Immediately after, standard 3-port vitrectomy was performed. RESULTS: The prevailing vitreoretinal pathology was retinal detachment, with 1 case of macular pucker and 1 case of macular hole. In all cases, the IOL was implanted in the capsular bag. There were no intraoperative complications during the cataract surgery or vitrectomy. Follow-up 1, 15, 30, 90, and 180 days after surgery showed significant visual recovery in all cases. The mean endothelial loss was 10.05% +/- 2.01% (SO). In 3 cases that had tamponade with heavy silicone oil, progressive posterior capsule opacification occurred 6 months after surgery. CONCLUSIONS: Bimanual microphacoemulsification combined with vitrectomy was effective and sate. The microincisions and 19-gauge instruments provided excellent chamber resistance that simplified surgical maneuvers in eyes that might have a distorted fundus reflection and increased zonular laxity. The Acri.Smart 46 S IOL, which can be injected through a 2.0 mm incision, provided good fundus visibility during vitrectomy and good maneuverability up to the extreme periphery without resulting in glare or distracting reflections for the surgeon.