Retinal problems may be under-recognized in cataract patients, surgeon says

PHILADELPHIA — Ophthalmologists should take extra care when performing cataract surgery on patients who have pre-existing retinal conditions, according to one ophthalmologist.

Harry W. Flynn, Jr., MD, said diseases such as diabetic macular edema, choroidal neovascularization (CNV) and retinal tears must be evaluated and treated before the patient undergoes cataract surgery to ensure good outcomes and satisfied patients.

“CNV in particular may be under-recognized in the cataract population,” he said. “CNV should be stabilized prior to surgery, and ophthalmologists should defer surgery until optical coherence tomography (OCT) imaging demonstrates improvement.”

Here at the Wills Eye Hospital Annual Alumni Conference Dr. Flynn said he recommends treatment with pegaptanib, bevacizumab, verteporfin or photocoagulation before cataract surgery.

Dr. Flynn said peer-reviewed evidence that shows cataract surgery to be a risk for exacerbating retinal disease is controversial. He said that the pooled data from three population-based studies suggest a connection between late age-related macular degeneration and a history of cataract surgery, but no causal link has been established.

However, he said traditional ophthalmoscopy might miss subretinal fluid, hemorrhage or lipid exudates, making OCT a useful diagnostic tool.