Cataract Surgery Improves Vision For Most With History of Retinitis Pigmentosa

Among patients with retinitis pigmentosa (RP) undergoing cataract surgery, postsurgical visual outcomes were predicted by preoperative best-corrected visual acuity (BCVA), according to study findings published in the American Journal of Ophthalmology.

The retrospective study was conducted at sites in the Netherlands (n=5), the United Kingdom (n=1), Belgium (n=1), Czech Republic (n=1), and Lithuania (n=1). Predictors for visual outcomes following cataract surgery were evaluated among 226 patients (n=295 eyes) with RP.

The patients were aged mean 56.1±17.9 years, 50% were women, 83% had no other ocular comorbidities, and baseline BCVA was ≥20/40 (17%), 20/67 to <20/40 (16%), 20/200 to <20/67 (34%), 20/400 to <20/200 (3%), or ≤20/400 (30%).

The patients had autosomal recessive (53%), autosomal dominant (36%), and X-linked (11%) RP and posterior subcapsular (61%), mixed (21%), nuclear (13%), mature (3%), and cortical (2%) cataracts.

All cataracts were extracted using phacoemulsification and most received a monofocal intraocular lens (97%) comprised of hydrophobic acrylic biomaterial (92%). The intraoperative complication rate was 6%. The complications included zonal dialysis (n=15), posterior capsular ruptures without vitreous loss (n=2), intraoperative miosis (n=1), and broken hepatic intraocular lens (n=1).

Postoperative complications occurred among 11%. The events included exacerbation of cystoid macular edema (25%), development of cystoid macular edema (19%), corneal edema (16%), capsular phimosis (16%), increased intraocular pressure (13%) intraocular lens subluxation (9%), and endophthalmitis (3%). A total of 38% of eyes required laser posterior capsulotomy due to the development of significant posterior capsular opacification.

Following the surgery, BCVA improved by -0.22 logMAR (P <.001) in the first eye and by -0.24 logMAR (P <.001) in the second eye, where applicable.

Most patients self-reported visual improvement, but 20% reported no change and 7% reported poorer vision.

A marked improvement in BCVA (>0.3 logMAR) following surgery was significantly associated with preoperative BCVA <20/200 (adjusted odds ratio [aOR], 4.36; 95% CI, 2.0-9.46) and preoperative BCVA 20/200 to <20/67 (aOR, 3.60; 95% CI, 1.74-7.46). Gender, age, ocular comorbidities, intraoperative or postoperative complications, and posterior capsular opacifications were not significant predictors for visual outcomes.

This study may have been limited by not having access to advanced imaging data.

“This study suggests that cataract surgery leads to significant improvements in BCVA in the majority of patients with RP, with baseline BCVA being a potential predictive factor. Patients may experience subjective visual improvement, irrespective of their visual outcome. Surgeons should be aware of the high prevalence of zonular weakness and cystoid macular edema, which may warrant additional preparation. A high rate of posterior capsular opacifications is also present, which requires early treatment with laser posterior capsulotomy,” the study authors explain.