While retinitis pigmentosa is considered a rare disease, it occurs with enough frequency that every cataract surgeon will encounter it during his career. These patients can develop cataracts at an early stage, typically posterior sub-capsular cataracts, and with unique challenges. Our goal is to get as much light focused as possible with our cataract surgery in order to maximize the resultant vision from the impaired retina. Patients with retinitis pigmentosa must understand that while cataract surgery may improve their vision, it is typically a modest improvement only because the principal visual issue is the retinal disease.
During cataract surgery, we find that these patients often have very loose or lax zonules. We can see this when starting the capsulorhexis since the anterior capsule will be loose and not taut like the head of a drum. When we poke into the anterior capsule, it gives and begins to wrinkle. This same wrinkling is seen during the circular tearing of the capsulorhexis since the zonular structures are not securely holding the capsule. These patients may benefit from a capsular tension ring if focal areas of zonular weakness are noted, and a three-piece IOL may afford additional options such as sulcus placement or suture fixation.
These patients also have a higher risk of postoperative retinal complications such as cystoid macular edema. Studies have shown that patients with retinitis pigmentosa have sustained chronic inflammation and this may contribute to the increased risk of RP. Postoperatively, prolonged anti-inflammatory agents such as steroids and NSAIDs can help in the treatment or prevention of macular edema.
These patients are at a high risk of capsular phimosis months or years after the surgery. They should be monitored and if they start to develop anterior capsular phimosis, this can be addressed with the YAG laser.
Click below to learn from the video of cataract surgery in retinitis pigmentosa
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