EyeWorld India June 2021 Issue

CATARACT EWAP JUNE 2021 27 vitrectomy or intravitreal injections, Dr. Charles said to look for vitrectomy-related defects in the posterior capsule in the office with a widely dilated pupil and remain cautious and aware during cataract surgery. Patients with a history of pars plana vitrectomy may pose surgical challenges due to weakened zonules, posterior capsular violation, floppy capsule due to absence of vitreous, or poor dilation, Dr. Weng said, adding that intravitreal injections have also been associated with weakened zonules, as well as an increased risk of posterior capsular rupture. 3 “Having multiple types of IOLs and iris expansion/capsular tension stabilizing devices available as well as avoiding significant traction on the zonules during phacoemulsification is advisable,” she said. EWAP References 1. Romero-Aroca P, et al. Nonproliferative diabetic retinopathy and macular edema progression after phacoemulsification: prospective study. J Cataract Refract Surg . 2006;32:1438–1444. 2. Pollack A, et al. Progression of diabetic retinopathy after cataract extraction. Br J Ophthalmol . 1991;75:547–551. 3. Siddiqui MZ, et al. Visual outcomes and intraoperative complications of cataract surgery in nAMD: A multicenter database study. Poster presentation Dr. Devgan offered several other retinal situations to be aware of and shared cases from his Cataract Coach website. Vitreomacular traction If you see vitreomacular traction on the OCT, Dr. Devgan said not to rush into cataract surgery because when the thick cataractous lens is replaced by the thin IOL, the vitreous will shift. Vitreomacular traction can be hard to detect, he noted. It can lead to PVD and potentially even full-thickness macular hole, cystoid macular edema, and poor vision. When vitreomacular traction is detected, Dr. Devgan suggested delaying cataract surgery and coordinating with retina specialists who may inject lytic agents or rarely do a pars plana vitrectomy. Retinitis pigmentosa Patients with retinitis pigmentosa may develop cataract at an earlier stage, and with this underlying retinal disease, the cataract surgery may only improve their vision slightly. These patients may have zonular weakness during surgery and may also have a higher risk of postop retinal complications like CME. According to Dr. Devgan, these patients are also more prone to capsular phimosis after surgery. Epiretinal membrane Dr. Devgan noted that up to 20% of cataract patients may have epiretinal membrane, and it’s important to critically evaluate the retina prior to the cataract surgery. Some epiretinal membranes may have only a minimal effect on vision, but larger ones can cause macular distortion and issues with vision following cataract surgery. They could also add to potential postop complications such as cystoid macular edema. A 68-year-old patient with dry AMD (bottom) had a single-piece acrylic monofocal IOL placed in the capsular bag (top) during cataract surgery. Source: Christina Weng, MD, MBA A 75-year-old patient developed a posterior vitreous detachment 3 weeks after uncomplicated cataract surgery in one eye. Take note of other retinal issues at the 2020 American Academy of Ophthalmology Virtual Congress. Editors’ note: Dr. Charles practices at Charles Retina Institute, Germantown, Tennessee. Dr. Devgan is Clinical Professor of Ophthalmology, Jules Stein Eye Institute, UCLA, and Chief of Ophthalmology, Olive View UCLA Medical Center, Los Angeles, California. Dr. Weng is Associate Professor of Ophthalmology and Fellowship Program Director Vitreoretinal Diseases and Surgery, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. None of the doctors declared any relevant financial interests.