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Physician addresses effects of cataract surgery on posterior segment
 Heinrich Heimann |
LONDON — The effects of cataract surgery on the posterior segment of the eye and the associated risks are often underestimated, according to a surgeon speaking at the Euretina meeting here.
"Cataract surgery produces posterior segment changes, acute and chronic, including inflammation, barrier breakdown, long-lasting biochemical changes and posterior vitreous detachment, occurring in 60% of the cases," Heinrich Heimann, MD, said.
When coexisting pathologies such as diabetes and age-related macular degeneration are present, the related risks could be high.
"Patients with diabetes have a two- to fourfold increased risk of developing cataract. About 20% of patients undergoing cataract surgery have diabetes, and they all have an increased risk of developing cystoid macular edema, even if retinopathy is not present," Dr. Heimann said.
If retinopathy is evident, it should be treated and surgery should be postponed for 6 to 12 months. If surgery is urgent, combined anti-VEGF treatment is mandatory, Dr. Heimann said.
The relationship between cataract surgery and AMD or AMD progression is a controversial issue, with large studies reaching very different conclusions.
The incidence of retinal detachment, on the other hand, is underestimated, according to Dr. Heimann.
"Perhaps because [retinal detachment] tends to occur approximately 4 years after surgery, the causative relationship is often disregarded," he said. However, overall there is a ninefold increase in the retinal detachment rate 8 years after cataract surgery.
High myopia, young age and male sex are additional risk factors, resulting in a 20% risk for young male myopes to have retinal detachment after cataract surgery.
"Therefore, be cautious and avoid unnecessary [phacoemulsification] in these patients," Dr. Heimann said.
- Disclosure: Dr. Heimann has no relevant financial disclosures.