Long-term clinical results after cataract surgery with and without capsular tension ring in patients with retinitis pigmentosa: a retrospective study

Abstract

ObjectivesTo describe the long-term clinical outcomes after cataract surgery with and without capsular tension ring (CTR) in a group of patients with retinitis pigmentosa (RP).DesignA retrospective study.SettingTertiary referral centre.Participants52 eyes (46 patients) with RP.InterventionsCataract surgery was undertaken between October 2002 and May 2010.Primary and secondary outcome measuresVisual acuity, secondary cataract, capsular contraction syndrome (CCS), intraocular pressure, cystoid macular edema (CME), intraocular lens dislocation and endophthalmitis.ResultsThe mean age at surgery was about 53 years and the overall mean follow-up was 26 months (range 3–60 months). The mean preoperative logarithm of the minimal angle of resolution of the best corrected visual acuity (LogMAR BCVA) in the entire group was 1.45±0.85 (95% CI 1.21 to 1.69) and had increased to 1.32±0.95 (95% CI 1.06 to 1.58, p=0.02). The mean preoperative and the mean postoperative LogMAR BCVA in the non-CTR group (group 1) improved from 1.16±0.8 (95% CI 0.83 to 1.48) to 0.98±0.88 (95% CI 0.62 to 1.33, p=0.02) and in the CTR group (group 2) from 1.74±0.81 (95% CI 1.42 to 2.07) to 1.66±0.90 (95% CI 1.3 to 2.03, p=0.31), respectively. Secondary cataract was observed in a total of 23 eyes (44%), of which 13 (50%) were belonged to group 1 and 10 (38%) to group 2. CCS was seen in a total of two eyes (4%) all under group 1. CME was noted in two eyes (4%), of which one belonged to group 1 and a second one to group 2. Endophthalmitis was not observed in any group.ConclusionsBoth surgical approaches were beneficial to the RP patients. Eyes under group 2 showed less long-term postoperative complications. This includes secondary cataract and CCS. Eyes under group 1 performed significantly better in respect of visual acuity. Further research would include insights into the genetic subsets.

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

“…Celik et al [ 93 ] indicated that RP with zonular weakness is one of the indications for CTR implantation. In the study of Bayyoud et al [ 13 ], they demonstrated RP eyes under phacoemulsification and IOL implantation with CTRs showed less long-term postoperative complications, such as PCO (23/52, 44%), capsular phimosis (2/52, 4%), and improved visual acuity at a mean follow-up time of 26 months. Conversely, some reported cases still exhibit late-onset subluxation or dislocation of IOL or CTR-IOL-capsular bag complex, perhaps indicating the insufficient strength of standard CTR to support a profound zonular weakness [ 67 , 96 ].…”

“…Based on the constrict visual field, loss of transparency in the eyes with RP only in a small part of the lens can lead to disproportionate visual acuity reduction [ 7 ]. Furthermore, compared with the mean age at surgery of 72–74 years for age-related cataract (ARC) [ 8 ], the surgery time in RP is earlier, with an average age at surgery of 47–63 years old in previous studies [ 6 , 8 – 13 ] and 83% of the patients with mean age at surgery between 30 and 59 years in the study of Bastek et al [ 14 ]. The decreased visual acuity with continuous development of cataracts severely influences the patient's life quality.…”

“…In addition, there are still no effective and curative pharmacologic treatments for patients with cataracts [ 15 ]. Despite the potentially poor results of re-impaired visual acuity caused by the surgery complications, including phototoxic retinal damage during the surgery, postoperative posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased intraocular pressure (IOP), and intraocular lens (IOL) dislocation [ 6 , 8 , 10 , 12 , 13 , 16 , 17 ], significant improvement of visual acuity and subjective symptoms in the majority of patients were also published in many studies [ 6 , 8 – 14 , 16 , 18 , 19 ].…”

Clinical Characteristics and Current Therapies for Inherited Retinal Degenerations

“…As a general guideline, cataract surgery is indicated in individuals with lens opacities and should be performed as soon as it causes significant impairment of vision and before the disease evolves to a point at which it could limit postoperative recovery. In general, RP patients experience significant improvements in visual acuity after cataract surgery (reviewed in Bayyoud et al 2013;Dikopf et al 2013). However, patients should be informed that postoperative visual acuity cannot be accurately predicted before surgery because the part of cataract versus the part of macular dysfunction in the decrease of vision is sometime difficult to evaluate.…”

Outcomes following cataract surgery in choroideremia

“…By comparison, aggressive capsularphimosis, zonular weakness and IOL dislocation have all been reported in retinitis pigmentosa. 13,[17][18][19][20][21][22][23] Phototoxicity is a serious consideration in the context of attenuated photoreceptor and RPE function as seen in choroideremia. The main risk factor for phototoxicity is the duration of surgery, 24,25 which was kept to a minimum in all the patients and the eye was shielded from the microscope light during the pauses in operating.…”