The risk of ischemic optic neuropathy post phacoemulsification cataract surgery

Abstract

IntroductionThe aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery.MethodsThis study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy.ResultsA total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B.ConclusionPhacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.

Influence of cataract surgery on macular vascular density in patients with myopia using optical coherence tomography angiography

“…Clinically, there have been certain reports of ischemic optic neuropathy occurring after cataract surgery and leading to a sudden decline in VA (3,4). Another study suggested that the macular vascular system was essential to visual function (5).…”

“…Phacoemulsification combined with intraocular lens implantation is an effective treatment method to improve VA (2). However, certain patients with cataracts experience a decrease in VA at different time-points after surgery (3,4). For instance, Emeriewen et al (3) studied the decreased VA after cataract surgery caused by ischemic optic neuropathy and reported that hypertension, diabetes, cerebrovascular disease and high levels of lipids were systemic risk factors.…”

Post-cataract surgery optic neuropathy: a chronological narrative review of the literature and speculation on pathogenesis

“…Thus, it could not be determined if cataract surgery incurs a higher risk of PCSON in those patients with a history of fellow eye PCSON. Following the seminal contributions by McCulley et al [28] in the early 2000s, there were no further studies of PCSON until 2017, when Al-Madani and associates from Amman, Jordan reported the results of a case-controlled study in which they identified 13 cases of PCSON (half occurring within 1 week of surgery) following 307 cataract surgeries, a significantly higher frequency when compared with the incidence of NAION in the no-cataract surgery cohort (4.2% vs. 0.4%, respectively). In this series, four of 21 (19%) patients with a history of fellow eye NAION developed PCSON.…”

“…Since 2000, there have been nine studies that have investigated the association of an acute anterior optic neuropathy following apparently uncomplicated cataract surgery (Fig. 2, Table 1) [24–29,30 ▪▪ ,31,32 ▪▪ ]. All of these studies have been retrospective but with different methodologies: comparative case series, surgeon survey, nationwide-claim database, case-controlled, and population-based [13 ▪ ].…”

Brinzolamide–brimonidine fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

“…Furthermore, postoperative IOP elevation has been recognized as an independent risk factor for postoperative anterior ischaemic optic neuropathy in eyes with susceptible optic nerve head circulation 3 or to non-arteritic ischaemic optic neuropathy. 4 However, the most common manifestations of IOP increase after cataract surgery are ocular pain and corneal oedema.…”