Cataract surgery in RP patients: Marked improvements in BCVA

According to investigators, surgeons should be aware of the high prevalence of zonular weakness and cystoid macular edema, which may warrant additional preparation in these patients.

Most patients with retinitis pigmentosa (RP) who underwent cataract surgery

had significant improvements in the best-corrected visual acuity (BCVA), according to research by

Xuan-Thanh-An Nguyen, MD, and colleagues at the Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.

In this retrospective, non-comparative clinical study,1 the investigators evaluated the preoperative, intraoperative, and postoperative data of the 225 study patients (295 eyes; mean patient age, 56.1 years) collected from several European centers.

Nguyen reported that after surgery, the BCVA improved significantly from 1.03 to 0.81 logarithm of the minimum angle of resolution (logMAR) visual acuity, that is, from 20/214 to 20/129 Snellen in the first treated eye (-0.22 logMAR; 95% confidence interval [CI], -0.31 to -0.13; p < 0.001) and from 0.80 to 0.56 logMAR, that is, 20/126 to 20/73 Snellen in the second treated eye (-0.24 logMAR; 95% CI, -0.32 to -0.15; p < 0.001).

Thirty-nine percent of patients (87 of 225 patients) achieved “marked” improvements in the postoperative vision, defined as a change in BCVA of 0.3 logMAR or greater. Patients with moderate visual impairment or worse had increased odds of this marked improvement.

According to the investigators, the most common complications in this patient population were zonular dialysis in 15 patients and exacerbation of cystoid macular edema in 14 patients. Postoperative posterior capsular opacifications developed in 111 of the 295 eyes.

The investigators noted that the take-home messages were that patients with RP can achieve significant improvement in the BCVA after cataract surgery, and the baseline BCVA is a potential predictive factor.

Moreover, the investigators advised that surgeons should be aware of the high prevalence of zonular weakness and cystoid macular edema, which may warrant additional preparation in these patients. The high incidence of posterior capsular opacification requires early treatment with laser posterior capsulotomy.

The investigators said they believe that future studies should include spectral-domain imaging and patient-reported outcome measures, which may be important parameters for evaluating visual outcomes.

“This knowledge can be used to guide ophthalmologists and counsel patients with RP who are considering cataract surgery,” the investigators concluded.

Reference

1. Nguyen XTA, Thiadens AAHJ, Fiocco M, et al. Outcome of cataract surgery in patients with retinitis pigmentosa. Am J Ophthalmol. Published online October 14, 2022; doi:https://doi.org/10.1016/j.ajo.2022.10.001