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  • Cataract Surgery Improves BCVA in Patients With RP

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, February 2023

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    The photoreceptor loss that occurs with retinitis pigmentosa (RP) may cause night blindness, concentric loss of pe­ripheral visual fields, and loss of central vision. The most common RP-related anomaly of the anterior segment is cat­aract, which forms at a relatively young age in patients with RP. Although the usual treatment is surgical cataract extraction plus IOL implantation, the visual prognosis following surgery is uncertain for these patients. Moreover, patients with RP are susceptible to in­traoperative phototoxic retinal damage, cystoid macular edema (CME), and weakened lens zonules—all of which can adversely affect vision and raise the risk of complications. Even so, explor­ing factors that influence visual out­comes in patients with RP who under­go cataract surgery may help physicians to select candidates who are most likely to benefit from the procedure. Nguyen et al. retrospectively explored outcomes of cataract surgery in patients with RP. They found that BCVA improved significantly in most patients.

    For this work, the authors gathered data from European academic centers with expertise in performing cataract surgery for RP. They extracted relevant clinical data from patients’ medical records, including pre-, intra-, and post-op information. Excluded from the analysis were patients who did not receive an IOL or whose surgery in­volved both the anterior and posterior segment (e.g., phacovitrectomy). The main outcome measure was change in BCVA from pre-op status.

    Overall, 295 eyes (226 patients) met the inclusion criteria. The mean age at first-eye surgery was 56.1 ± 17.9 years. Mean BCVA improved significantly after the surgery, from 1.03 to .81 log­MAR (20/214 to 20/129) in the first eye (p < .001) and from .80 to .56 logMAR (20/126 to 20/73) in the second eye (p < .001). Marked BCVA improve­ment, defined as a BCVA change from baseline of ≥0.3 logMAR, occurred in 39% of patients. Patients with poorer vision preoperatively had the best odds for marked improvement. The most common intraoperative complications were zonular dialysis (n = 15; 5%) and CME exacerbation (n = 14; 5%). Post-op posterior capsular opacification was observed in 38% of eyes.

    The authors recommend that pre-op evaluations include identifying CME and the potential for zonular insuffi­ciency. They hope that spectral-domain OCT and patient-reported outcomes will be included in future studies because the findings may be useful adjuncts to assess visual outcomes.

    The original article can be found here.