Cataract extraction in eyes with diabetic iris neovascularization

Iris neovascularization used to be considered a strict contraindication to intraocular surgery, especially intraocular lens implantation. In this study, the authors analyzed whether cataract extraction and posterior chamber lens implantation is associated with unacceptable intraoperative and early postoperative complications in patients with proliferative diabetic retinopathy and rubeosis iridis.

Using a computerized data retrieval system, the authors identified all the patients with manifest iris neovascularization and proliferative diabetic retinopathy who underwent cataract extraction in their institution between 1989 and 1995. The preoperative, intraoperative, and early postoperative data were analyzed retrospectively with regard to complications and visual results.

Thirty-nine eyes of 33 patients (mean age 64.6 +/- 10.9 years) with manifest pupillary rubeosis iridis were analyzed. All but 3 of the eyes had undergone previous retinal laser treatment, with dense cataracts preventing additional photocoagulation. Additional chamber angle neovascularization was present in 11 eyes. Posterior chamber intraocular lenses were implanted in 35 eyes. Intraoperatively, iris hemorrhage was noted in 10 eyes and was significantly more frequent in eyes that underwent nuclear expression (50%) than in those that underwent phacoemulsification (12%; P = .019). Postoperatively, spontaneously resolving hyphema was observed in 7 eyes as well as reversible fibrin formation in 6 eyes. No severe sight-threatening complications occurred. Visual acuity improved in 33 (85%) of the eyes.

Cataract extraction with posterior chamber lens implantation does not appear to be associated with unacceptable intraoperative or early postoperative complications. However, adequate treatment of underlying diabetic retinopathy prior to cataract extraction (and if necessary, postoperatively) is essential to prevent the progression of retinal and iris neovascularization.