Surgical Retina by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9789811362149
Publisher: Springer Singapore

5.2.4 Miscellaneous

5.2.4.1 Cataract

Patients with diabetes have a higher rate of cataract development than the average population [50]. It is not uncommon for the cataract and/or posterior synechiae from anterior segment neovascularization to limit examination of the retina and/or prevent adequate panretinal photocoagulation. In these situations, cataract surgery is needed. If there is significant posterior neovascularization, the rapid development of a posterior vitreous detachment that can happen with cataract surgery may sometimes lead to vitreous hemorrhage. Additionally, cataract surgery can worsen diabetic retinopathy. The presence of diabetic retinopathy should not be prohibitory to cataract surgery, but preoperative treatment with either laser and/or anti-VEGF medications may be warranted [50].

Combined cataract surgery and PPV can be done when the view to the retina is suboptimal from the dense cataract [51]. In these surgeries, it is particularly important to minimize phacoemulsification energy to keep the cornea as clear as possible for the retina surgery. Additionally, a more rigid three-piece intraocular lens and placing of a corneal suture at the main cataract incision can help keep the intraocular lens and globe stable during and following retinal surgery. There are varying views on the timing of intraocular lens—before vitrectomy or afterward. Placing the intraocular lens at the end of the procedure allows an improved view of the periphery through an aphakic eye and may be advantageous in anterior dissections [51].

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