The Postvitrectomy Cataract

Markatia, Zahra; Hudson, Julia; Leung, Ella H.; Sajjad, Ahmar; Gibbons, Allister

doi:10.1097/iio.0000000000000440

Cited by 6 publications

(4 citation statements)

References 68 publications

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“…Previous intravitreal injection may increase the chances of posterior capsule rupture (PCR), or be a cause of direct breach due to trauma with the intravitreal needle[ 22 ]. Any previous vitreoretinal intervention may cause zonular instability, or be the cause of cataracts in the first place[ 23 ]. Thus, the possibility of vitreous prolapse must be anticipated and the surgery planned accordingly.…”

Section: Challenges In Cataract Surgery In Diabetesmentioning

confidence: 99%

“…Lens-bag instability can be challenging to manage in the setting of pre-existing vitreoretinal complications. Therefore, in diabetic eyes, implantation of a capsular tension ring (CTR) during cataract surgery may help to anchor the IOL-bag complex even in subsequent surgeries, should the need arise[ 23 ]. There is, however, no guideline regarding the circumstances in which the CTR should be implanted, and the choice is on the surgeon to decide.…”

Section: Challenges In Cataract Surgery In Diabetesmentioning

confidence: 99%

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Intraocular lens selection in diabetic patients: How to increase the odds for success

Morya,

Nishant,

Ramesh

et al. 2024

World J Diabetes

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The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

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Section: Challenges In Cataract Surgery In Diabetesmentioning

confidence: 99%

Section: Challenges In Cataract Surgery In Diabetesmentioning

confidence: 99%

Intraocular lens selection in diabetic patients: How to increase the odds for success

Morya,

Nishant,

Ramesh

et al. 2024

World J Diabetes

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“…Conventionally, a subsequent approach is preferred for patients with PDR and mild cataracts. In these cases, the surgeons may preserve the lenses with accommodation after PPV and perform subsequent phacoemulsification with an intraocular lens (IOL) implantation 9-24mo later due to cataract aggravation [5][6][7][8][9][10][11][12][13][14] . However, the subsequent approach may have a potential risk of outcomes that fall short of expectations.…”

Section: Introductionmentioning

confidence: 99%

“…First, cataract aggravation is almost ineluctable and observed in 79%-95% of phakic patients after PPV [8][9][10][11][12][13][14] . Complicated cataracts may not only compromise visual rehabilitation in patients with PDR but also obscure the evaluation of retinal conditions after PPV [5][6][7][8][9][10] . In addition, fluctuations in the anterior chamber, zonular dehiscence, macular edema (ME), neovascular glaucoma (NVG), vitreous hemorrhage (VH), and lens subluxation are prevalent during or after the cataract surgery in patients with PDR and history of PPV [15][16][17][18][19][20] , bringing additional challenges and inconveniences for both the surgeons and patients with PDR.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract: a randomized clinical trial

Feng,

Li,

et al. 2024

Int J Ophthalmol

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AIM: To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) compared to those of PPV with subsequent cataract surgery. METHODS: This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR, aged >45y, with mild cataracts. The participants were randomly assigned to the combined (PPV combined with simultaneously cataract surgery, i.e., phacovitrectomy) or subsequent (PPV with subsequent cataract surgery 6mo later) group and followed up for 12mo. The primary outcome was the change in best-corrected visual acuity (BCVA) from baseline to 6mo, and the secondary outcomes included complication rates and medical expenses. RESULTS: In total, 129 patients with PDR were recruited and equally randomized (66 and 63 in the combined and subsequent groups respectively). The change in BCVA in the combined group [mean, 36.90 letters; 95% confidence interval (CI), 30.35–43.45] was significantly better (adjusted difference, 16.43; 95%CI, 8.77–24.08; P<0.001) than in the subsequent group (mean, 22.40 letters; 95%CI, 15.55–29.24) 6mo after the PPV, with no significant difference between the two groups at 12mo. The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma (17.65% vs 3.77%, P=0.005). No significant differences were found in the photocoagulation spots, surgical time, and economic expenses between two groups. In the subsequent group, the duration of work incapacity (22.54±9.11d) was significantly longer (P<0.001) than that of the combined group (12.44±6.48d). CONCLUSION: PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness, safety and convenience, compared to sequential surgeries.

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