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Cataract surgery by phacoemulsification in adults with retinopathy of prematurity
A K Farr1, W J Stark, J A Haller
1The Wilmer Ophthalmological Institute, The Johns Hopkins Hospitals, Baltimore, MD 21287-9028, USA. jhaller@jhmi.edu
Insights
Phacoemulsification cataract surgery in adults with retinopathy of prematurity is relatively safe and visually rehabilitating. Surgeons should be aware of potential challenges like zonular weakness and increased risks of retinal detachment.
Area of Science:
- Ophthalmology
- Retinopathy of Prematurity
- Cataract Surgery
Background:
- Adults with retinopathy of prematurity (ROP) can develop visually significant cataracts.
- ROP is associated with ocular complications that may complicate cataract surgery.
Purpose of the Study:
- To identify preoperative, operative, and postoperative factors associated with phacoemulsification cataract surgery in adults with ROP.
- To evaluate the safety and efficacy of phacoemulsification in this patient population.
Main Methods:
- Retrospective search of patient records at The Wilmer Institute (1990-2000).
- Inclusion criteria: adults with ROP who underwent phacoemulsification for cataract or phacomorphic glaucoma with at least 6 months of follow-up.
- 17 adults (20 eyes) were identified.
Main Results:
- Phacoemulsification was performed on 20 eyes, with 18 receiving posterior chamber intraocular lenses.
- Visual acuity improved in 18 of 20 eyes.
- Complications included zonular weakness in two eyes and one case of rhegmatogenous retinal detachment.
Conclusions:
- Phacoemulsification is a relatively safe and visually rehabilitating procedure for adults with regressed retinopathy of prematurity.
- Surgeons must consider challenges such as high myopia, glaucoma, and previous ocular surgery.
- Awareness of potential intraoperative zonular weakness and postoperative risks like retinal detachment is crucial.
Purpose:
To report the preoperative, operative, and postoperative factors associated with phacoemulsification cataract surgery in adults with retinopathy of prematurity.
Methods:
Records of patients with retinopathy of prematurity who underwent phacoemulsification at The Wilmer Institute between January 1990 and January 2000 were retrospectively searched. Seventeen adults (9 women, 8 men) with retinopathy of prematurity were identified who had undergone phacoemulsification for visually significant cataract or phacomorphic glaucoma and who had at least 6 months of postoperative follow-up.
Results:
Cataract extraction by phacoemulsification was performed on 20 eyes. Follow-up ranged from 6 to 103 months (mean, 32 months). A posterior chamber intraocular lens was placed in 18 eyes; two eyes were left aphakic for refractive reasons. Zonular weakness was noted in two eyes in which the intraocular lens was suture fixated to the sclera. Concomitant trabeculectomy was performed in one eye. Visual acuity improved in 18 of 20 eyes and remained unchanged in two eyes. Postoperatively, visual acuity was worse than 5/200 in two eyes, 5/200 to worse than 20/100 in five eyes, 20/100 to 20/50 in five eyes, and 20/40 or better in eight eyes. One eye developed a rhegmatogenous retinal detachment 1 month after cataract surgery; the retina was successfully reattached.
Conclusions:
Although cataract extraction in eyes with regressed retinopathy of prematurity may present challenges, such as high myopia, monocularity, glaucoma, and previous ocular surgery, phacoemulsification in this series proved to be relatively safe as well as visually rehabilitating. The surgeon should be aware of the special considerations in this population, alert to potential zonular weakness intraoperatively, and careful of increased postoperative risks, including retinal detachment.
