4/15/2023 0 Comments Retinal lattice degenerationThe ongoing debate is whether uncomplicated cataract surgery can contribute to AMD progression. At right, wet AMD eight weeks post-cataract surgery with recurrent activity. 4Īt left, a fundus image of wet AMD post-injections and pre-cataract surgery. 4 Cataracts are the leading cause of reversible blindness worldwide and, ultimately, removal of a cataract will improve visual function whether or not the patient has AMD. 2ĪMD remains the leading cause of legal blindness in patients older than 65, despite efforts to identify these individuals early in the course of the disease. Investigators have demonstrated that the risk of postsurgical cystoid macular edema in a patient with a history of a RVO is up to 30 times higher, and the risk persisted even in eyes without preoperative macular edema. When considering cataract surgery in a patient with a history of a retinal vein occulusion, it is best to wait until the macular edema has resolved and remains stable for two to three months without intervention, unless the cataract precludes visualization of the posterior pole. Avastin (bevacizumab, Genentech), although not FDA approved for use in the eye, is still a common first-line agent. Intravitreal agents Lucentis (ranibizumab, Genentech), Eylea (aflibercept, Regeneron) and Ozurdex (dexamethasone, Allergan) are currently FDA approved for the treatment of macular edema secondary to a retinal vein occlusion. The goal of treatment is to suppress the edema however, many patients with a retinal vein occlusion will require months of treatment. Using SD-OCT, clinicians can evaluate the degree of macular edema through retinal contour maps, follow the response of treatment and adjust accordingly. It should be performed on patients with an RVO, especially if the RVO is associated with central vision loss, disc edema, multiple hemorrhages, cotton-wool spots or macular edema. Fluorescein angiography (FA) is the standard diagnostic test for identifying capillary drop out and retinal ischemia. 3 When considering cataract surgery in a patient with a history of RVO, be sure the patient is completely free of retinal ischemia and check whether any macular edema is present. Retinal vein occlusion (RVO) is the second most common retinal vasculature disease after diabetic retinopathy. 2 Although treatment of macular edema secondary to epiretinal membrane may not improve visual symptoms, it may reduce the risk of postoperative exacerbation. Because the risk of post-cataract CME is increased in patients with an epiretinal membrane, any macular edema should be treated to establish some level of stability prior to clearing a patient for surgery. 2 It is important to identify macular edema when considering a patient for cataract surgery. OCT reveals epiretinal membrane with cystoid macular edema.Ĭystoid macular edema (CME) is one complication of epiretinal membrane. Spectral-domain OCT (SD-OCT) has allowed clinicians to visualize the anterior retina and the vitreoretinal interface with much greater detail than fundus photography and, in some instances, better than the clinical exam. Some membranes are easily seen clinically whereas others are not. 1 The incidence increases with age, as follows: 1 1 The Blue Mountains Eye Study shows the prevalence of an epiretinal membrane varies-estmating that 7% of patients older than 49 years of age will have an epiretinal membrane, 31% of which are bilateral. This article will outline the more common conditions associated with a higher risk of postoperative complications of cataract surgery.Įpiretinal membranes are common in potential cataract surgery patients. Using this technology, we’ve been able to increase our understanding of the possible relationship between cataract surgery and some retinal pathologies. Today, imaging tools allow a visual assessment of the posterior pole to a greater degree than ever before. Peripheral findings that may be relevant to postoperative outcomes include lattice degeneration, retinal breaks, operculated holes, cystic retinal tufts and the whole family of pathologies related to vitreous traction. In addition, peripheral retinal lesions may also have bearing on complications. Multiple retinal conditions may impact cataract surgery outcomes, including disorders such as: This patient has non-proliferative diabetic retinopathy with clinically significant macular edema. Despite how commonplace cataract surgery has become, postoperative challenges may still occur, particularly when pre-existing retinal pathology is involved.
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