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Clement Chow, Mark Dikopf, William Mieler, Elmer Tu; Cataract Extraction Outcomes and the Prevalence of Zonular Insufficiency in Retinitis Pigmentosa. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1262.
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To report surgical outcomes and the prevalence of zonular insufficiency in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction.
Single institution retrospective study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012. Preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium aluminum garnet (YAG) laser capsulotomy, and surgical complications.
Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range 31-78 years). Mean follow up time was 23.3 months (range = 1 day - 95 months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the Minimum Angle of Resolution [logMAR] 1.23) to 20/129 (0.81) within three months of surgery, P < 0.0001. When focusing on eyes with a preoperative vision of 20/40 to 20/200 (47 eyes), visual acuities improved from a mean of 20/81 (logMAR 0.61) to 20/43 (0.33), P < 0.0001. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8 months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively and 4 post-operatively). One patient had bilateral dislocated in-the bag intraocular lenses at 5.5 years and 6 years after surgery.
Cataract surgery yields significantly improved visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuity of 20/400 or worse have more limited objective improvements likely because of macular involvement, but may still have considerable subjective improvements. A high incidence of zonular instability is seen in the RP population. It is important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.
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