Nuclear Sclerotic Cataract Risk is Low Following PPV in Younger Patients 

Nuclear sclerotic cataract risk may be significantly lower among individuals younger than 35 years who undergo pars plana vitrectomy (PPV) for macula-on rhegmatogenous retinal detachment (RRD) compared with individuals older than 35 years who undergo the procedure, according to a paper presented at the American Society of Retina Specialists meeting, held in Seattle, July 28 to August 1, 2023. Overall, cataract formation is more likely to follow PPV compared with a combined PPV and scleral buckle or scleral buckle alone, according to the report. 

Researcher Venkatkrish Kasetty, MD, a resident physician at Henry Ford Hospital, led a retrospective cohort study to assess cataract progression and nuclear sclerotic cataracts in patients aged between 15 and 45 years after uncomplicated RRD repair surgery.

The investigation included 36 eyes that were surgically treated for RRD between 2014 and 2020 at the Henry Ford Health System. Study participants, who were were previously naïve to retinal surgery, underwent either PPV (n=25; mean age, 35 years), scleral buckling (n=3; mean age, 27 years), or a combination of PPV and scleral buckling (n=5; mean age, 30 years).

After surgery, cataracts (both nuclear sclerotic cataracts and posterior subcapsular cataracts) developed in 71% of eyes that underwent PPV, 100% of eyes treated with both surgeries, and 33% of eyes that underwent scleral buckling. A majority of cataract development occurred within the first year. Ophthalmologists completed cataract extraction in 11 of the 20 eyes that developed cataract after PPV and in 1 of the 5 eyes that underwent both PPV and scleral buckling.

Among the patients who underwent PPV, nuclear sclerotic cataract was more likely to develop in individuals older than 35 years compared with those who were younger than 35 years (65% vs 18%; P =.022). Cataracts were more common after macula-off RRD compared with macula-on RRD (88% vs 50%; P =.044), and nuclear sclerotic cataracts were more common following macula-off RRD compared with macula-on RRD (75% vs 25%). All eyes with residual perfluoropropane 2 months after the surgery developed cataracts compared with 11 of 18 eyes without perfluoropropane at 2 months following the procedure (P =.047).

“[O]ur study may indicate that the risk of [nuclear sclerotic cataract] formation after PPV for macula-on RRD in younger eyes is minimal and may not be a significant consideration when choosing this repair [method],” according to the presenters. “Additionally, a shorter acting gas, such as SF₆, should be considered in younger eyes if appropriate based on the anatomical location of retinal breaks and percentage of retinal detachment.”

The researchers acknowledge that the small sample size was a limitation to the research.