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Retinal vascular disease patients requiring cataract surgery need careful preoperative evaluation
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MILAN — Cataract surgery in patients with retinal vascular disease requires careful preoperative evaluation, pre-treatment and constant postoperative monitoring, according to one surgeon.
At the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology, Keith A. Warren, MD, defined the combination of cataract surgery and retinal vascular disease as "the perfect storm." Surgeons should be well-prepared to deal with it and the potential consequences, considering that 15% of cataract patients in the U.S. have diabetes and 5% to 7% have a history of retinal vein occlusion. Consultation with a vitreoretinal specialist is highly recommended.
Keith A. Warren
Pre-surgical evaluation with optical coherence tomography and/or angiography should be performed. Prophylaxis should be done in all cases for at least 1 week, and in cases in which macular edema is already present, surgery should be delayed.
"The edema must be treated and controlled for at least 3 month prior to surgery," Warren said.
Approved treatment modalities includes anti-VEGF therapy, intravitreal corticosteroids, focal laser and NSAIDs. They have different effects on the complex chain reaction that leads to macular edema and should be considered according to the stage, type and etiology of the edema.
In most cases, anti-VEGF therapy is now considered as first-line treatment and may be combined with other treatments , Warren said.
Diabetic patients are at a higher risk of developing cystoid macular edema postoperatively.
"Evaluating whether the edema is due to postoperative cystoid changes or to the diabetes is crucial in deciding the treatment paradigm," Warren said.
"Control of CME is crucial in this patient population," he said, "because it frequently results in permanent loss of vision."
Disclosure: Warren is a consultant to Alcon and Genentech.