Eyeworld

56 | EYEWORLD | MARCH 2021 ATARACT C by Ellen Stodola Editorial Co-Director About the physicians Steve Charles, MD Charles Retina Institute Germantown, Tennessee Uday Devgan, MD Clinical Professor of Ophthalmology Jules Stein Eye Institute, UCLA Chief of Ophthalmology Olive View UCLA Medical Center Los Angeles, California Christina Weng, MD, MBA Associate Professor of Ophthalmology Fellowship Program Director Vitreoretinal Diseases and Surgery Cullen Eye Institute Baylor College of Medicine Houston, Texas membrane and diabetic macular edema," he said. "These high-risk patients are referred to our vitreoretinal colleagues for evaluation prior to cataract surgery." Christina Weng, MD, said that the exact timing for the exam will differ from provider to provider. She prefers to perform a dilated reti- nal examination approximately 1 month prior to planned cataract surgery for anyone with a history of high myopia or peripheral retinal issues, such as an old tear or lattice degenera- tion. "I prefer this timeframe because it is close enough to the surgery date that developing new pathology prior to the cataract extraction is less likely, but if any pathology is found, it poten- tially (although not always) could be treated without having to reschedule the surgery," she said. "Additionally, it gives you the opportunity to counsel the patient about the low risk of reti- nal detachment associated with cataract surgery and to review return precautions with them; the latter is crucial since cataract surgery often induces a postoperative PVD." Performing cataract surgery with retina abnormalities W hen performing cataract surgery, it's important to be aware of oth- er conditions and comorbidities, including issues with the retina. Several physicians discussed how to handle patients with retina abnormali- ties prior to cataract surgery. Retinal checks preoperatively Dr. Charles said that it's important to do a preop dilated peripheral retinal examination with an indirect ophthalmoscope to determine if there are retinal tears, holes, lattice, and areas of weakness. He said this check is very important for patients who are myopes, those with previ- ous tears or retinal detachment, but it should be done on all patients. Uday Devgan, MD, said that he will check the retinas of all patients who are having cata- ract surgery. "There are higher risk patients such as those with axial myopia, previous retinal issues like breaks or detachments, retinal vas- cular disease, and macular issues like epiretinal Take note of other retinal issues Dr. Devgan offered several other retinal situations to be aware of and shared cases from his Cataract Coach website. Vitreomacular traction If you see vitreomacular traction on the OCT, Dr. Devgan said not to rush into cataract surgery be- cause when the thick cataractous lens is replaced by the thin IOL, the vitreous will shift. Vitreomac- ular traction can be hard to detect, he noted. It can lead to PVD and potentially even full-thickness macular hole, cystoid macular edema, and poor vision. When vitreomacular traction is detected, Dr. Devgan suggested delaying cataract surgery and coordinating with retina specialists who may inject lytic agents or rarely do a pars plana vitrectomy. Retinitis pigmentosa Patients with retinitis pigmentosa may develop cataract at an earlier stage, and with this underlying retinal disease, the cataract surgery may only improve their vision slightly. These patients may have zonular weakness during surgery and may also have a higher risk of postop retinal complications like CME. According to Dr. Devgan, these patients are also more prone to capsular phimosis after surgery. Epiretinal membrane Dr. Devgan noted that up to 20% of cataract patients may have epiretinal membrane, and it's important to critically evaluate the retina prior to the cataract surgery. Some epiretinal membranes may have only a minimal effect on vision, but larger ones can cause macular distortion and issues with vision following cataract surgery. They could also add to potential postop complications such as cystoid macular edema.

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