EyeWorld India June 2021 Issue

CATARACT EWAP JUNE 2021 25 by Ellen Stodola Editorial Co-Director Contact information Charles : scharles@att.net Devgan: devgan@gmail.com Weng: christina.weng@bcm.edu This article originally appeared in the March 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. W hen performing cataract surgery, it’s important to be aware of other conditions and comorbidities, including issues with the retina. Several physicians discussed how to handle patients with retina abnormalities prior to cataract surgery. Retinal checks preoperatively Dr. Charles said that it’s important to do a preop dilated peripheral retinal examination with an indirect ophthalmoscope to determine if there are retinal tears, holes, lattice, and areas of weakness. He said this check is very important for patients who are myopes, those with previous tears or retinal detachment, but it should be done on all patients. Uday Devgan, MD, said that he will check the retinas of all patients who are having cataract surgery. “There are higher risk patients such as those with axial myopia, previous retinal issues like breaks or detachments, retinal vascular disease, and macular issues like epiretinal membrane and diabetic macular edema,” he said. “These high- risk patients are referred to Performing cataract surgery with retina abnormalities our vitreoretinal colleagues for evaluation prior to cataract surgery.” Christina Weng, MD, said that the exact timing for the exam will differ from provider to provider. She prefers to perform a dilated retinal examination approximately 1 month prior to planned cataract surgery for anyone with a history of high myopia or peripheral retinal issues, such as an old tear or lattice degeneration. “I prefer this timeframe because it is close enough to the surgery date that developing new pathology prior to the cataract extraction is less likely, but if any pathology is found, it potentially (although not always) could be treated without having to reschedule the surgery,” she said. “Additionally, it gives you the opportunity to counsel the patient about the low risk of retinal detachment associated with cataract surgery and to review return precautions with them; the latter is crucial since cataract surgery often induces a postoperative PVD.” Dr. Weng added that if a patient had a recent retinal detachment, she prefers to wait at least 3 months before proceeding with surgery. In patients with a prior PVD, she will not necessarily bring them in for a preop evaluation if the PVD occurred in the remote past and there are no other risk factors; if the PVD occurred recently, however, she does like to perform a scleral-depressed examination preoperatively. Cataract surgery in diabetics Dr. Weng said historically, there was a concern that inflammation from cataract surgery could induce cytokine release and breakdown of the blood-retinal barrier that could theoretically worsen diabetic macular edema (DME). The literature is mixed when it comes to the possibility of cataract surgery inducing DME, 1,2 but this association is less apparent in more recent studies that employ modern phacoemulsification techniques and technology, Dr. Weng said. “Remember that it can also be difficult to discern whether postoperative macular edema is truly an exacerbation of DME versus Irvine-Gass syndrome; a fluorescein angiogram can be helpful in these situations,” she said. Additionally, Dr. Weng said that if a patient has no history of DME, she does not specifically