A macula-off retinal detachment usually means a more limited visual prognosis because the critical central vision has been permanently altered from the event. However, in some cases there can be a remarkable recovery of vision. These patients often require a more complex retinal repair which includes a pars plana vitrectomy and injection of a gas bubble, both of which can induce a cataract.
This patient is younger and had a macula-off retinal detachment repaired about a year ago. The retina surgery was successful and the retina has remained attached and stable. A dense nuclear cataract developed in this eye and the vision declined to the Count Fingers level. He certainly could benefit from a cataract surgery, but we are not sure of the final visual potential which will be limited by the macular status.
What should we do differently in this case?
- with a prior vitrectomy, we need to understand that the absence of the anterior hyaloid face means less central support for the cataract during phaco. Explained in this article/video.
- we need to anticipate that the effective lens position may be deeper in the eye so we should add 0.5 D to the calculated IOL power to prevent a hyperopic surprise
- the anterior capsular opening should be about 5 mm in diameter so that it overlaps the 6 mm optic of the IOL for 360 degrees. Previously demonstrated in this article/video.
- ensure that the posterior capsule was not damaged during the prior retinal procedures. This is rare among experienced retina surgeons, but it can happen as shown in this article/video.
click below to learn form this case (shown unedited, start to finish):
The anterior chamber shallowed when removing the phaco probe and the I/A hand-piece. Have you thought about turning irrigation off before leaving the eye to try to keep the chamber maintained? My thought is that if the patient was going to have a redetachment due to cataract surgery, it would occur when the anterior chamber shallows. Cohesive viscoelastic could also be injected before removing the I/A hand-piece to maintain the chamber.
Great suggestions. I like the thinking behind that. Thanks for the contribution.