Virtually any intraocular procedure may be associated with cataract formation, either shortly after surgery or following a longer period of healing. Pars plana vitrectomy, especially with gas tamponade of the retina, is strongly associated with nuclear sclerotic cataract formation. A visually significant nuclear sclerotic cataract develops in 80%–100% of phakic eyes within 2 years of undergoing vitrectomy.
Figure 5-14 Inferior cortical opacification after capsule disruption by perforating injury.
(Courtesy of James Gilman, CRA, FOPS.)
Figure 5-15 Focal cortical cataract. A, Focal cortical cataract from a small perforating injury to the lens capsule as viewed by direct illumination. B, Focal cortical cataract viewed by retroillumination.
Postvitrectomy cataracts are less common in patients younger than 50 years. The formation of nuclear cataracts after vitrectomy is associated with increases in oxygen tension in the vitreous intraoperatively and postoperatively. (See Chapter 3 for a discussion of oxygen tension in the lens.) Retinal surgery performed without vitrectomy is not associated with increased nuclear sclerosis, but any disturbance of the capsule during a vitreous procedure may precipitate a PSC.
Intravitreal injections may be associated with cataract formation either as a result of direct trauma to the lens or as an adverse effect of specific medications injected into the vitreous space.
Trabeculectomy is a known risk factor for development of visually significant cataract. The Collaborative Initial Glaucoma Treatment Study found that glaucoma patients who were initially treated with trabeculectomy were 8 times more likely to need early cataract surgery than those patients who were initially treated with medications. At 5 years following trabeculectomy, this risk decreased to 3 times more likely.
Nuclear sclerotic cataract formation also occurs at significantly higher rates in patients who have received penetrating keratoplasty or Descemet stripping endothelial keratoplasty.
Feng H, Adelman RA. Cataract formation following vitreoretinal procedures. Clin Ophthalmol. 2014;8:1957–1965.
Musch DC, Gillespie BW, Niziol LM, et al; Collaborative Initial Glaucoma Treatment Study Group. Cataract extraction in the Collaborative Initial Glaucoma Treatment Study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes. Arch Ophthalmol. 2006;124(12):1694–1700.
Price MO, Price DA, Fairchild KM, Price FW Jr. Rate and risk factors for cataract formation and extraction after Descemet stripping endothelial keratoplasty. Br J Ophthalmol. 2010; 94(11):1468–1471.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.