Karti Omer, Saatci Ali Osman
Dokuz Eylul University, Department of Ophthalmology, Izmir, Turkey.
Med Hypothesis Discov Innov Ophthalmol. 2024 Aug 14;13(2):96-103. doi: 10.51329/mehdiophthal1500. eCollection 2024 Summer.
Retinitis pigmentosa (RP) is an inherited retinal dystrophy characterized by progressive vision loss due to photoreceptor degeneration. Complicated cataract formation, particularly posterior subcapsular cataract (PSC), frequently occurs in RP and exacerbates the visual impairment. Cataract surgery may improve vision; however, the distinctive challenges of RP require specific considerations. This mini-review aims to provide a comprehensive overview of the RP-related cataract.
A comprehensive literature review was conducted via PubMed/MEDLINE, spanning the period from January 1976 to June 2024, using the keywords "cataract," "cataract surgery," "cystoid macular edema," "hereditary retinal dystrophy," "retinitis pigmentosa," "posterior subcapsular cataract," "posterior capsular opacification," "zonular weakness," and "artificial intelligence." We aimed to evaluate cataract surgery in patients with RP, focusing on cataract formation, its surgical management, postoperative complications, patient follow-up, and visual outcomes. Relevant review articles, clinical trials, and case reports with related reference lists of these articles were included.
A total of 53 articles were examined in detail, including those identified through focused keyword searches and the reference lists of these articles. Cataract surgery in patients with RP generally results in substantial visual improvement. However, surgery can be complicated, particularly by zonular weakness and subluxation of the crystalline lens. These risks can be reduced by using capsular tension rings and employing meticulous surgical technique. Furthermore, postoperative complications, such as cystoid macular edema and posterior capsular opacification, are common. Despite these challenges, regular postoperative follow-up and appropriate management can help mitigate complications. Integrity of the ellipsoid zone and external limiting membrane on preoperative optical coherence tomographic examination are the main predictors of visual outcomes following cataract surgery; however, outcomes can vary. Though many patients experience significant visual improvement, some may experience limited benefits due to pre-existing advanced retinal degeneration.
Cataract surgery may offer meaningful visual benefits in patients with RP; however, careful preoperative evaluation and meticulous surgical technique are required to address the possible challenges. Attentive postoperative care and follow-up are essential to optimize visual outcomes. Early surgical intervention can significantly improve the quality of life in selected candidates, and tailored approaches are necessary in patients with RP requiring cataract surgery. Further studies on the potential application of artificial intelligence to monitor postoperative recovery and detect complications may improve surgical outcomes and enhance patient care.
视网膜色素变性（RP）是一种遗传性视网膜营养不良，其特征是由于光感受器退化导致进行性视力丧失。复杂白内障的形成，尤其是后囊下白内障（PSC），在RP中经常出现，并会加剧视力损害。白内障手术可能会改善视力；然而，RP的独特挑战需要特殊考虑。本综述旨在全面概述与RP相关的白内障。
通过PubMed/MEDLINE进行了全面的文献综述，时间跨度为1976年1月至2024年6月，使用的关键词有“白内障”“白内障手术”“黄斑囊样水肿”“遗传性视网膜营养不良”“视网膜色素变性”“后囊下白内障”“后囊膜混浊”“悬韧带松弛”和“人工智能”。我们旨在评估RP患者的白内障手术，重点关注白内障的形成、手术治疗、术后并发症、患者随访和视觉结果。纳入了相关综述文章、临床试验以及带有这些文章相关参考文献列表的病例报告。
共详细审查了53篇文章，包括通过重点关键词搜索确定的文章及其参考文献列表中的文章。RP患者的白内障手术通常会带来显著的视力改善。然而，手术可能会很复杂，尤其是晶状体悬韧带松弛和晶状体半脱位。使用囊袋张力环和采用精细的手术技术可以降低这些风险。此外，术后并发症，如黄斑囊样水肿和后囊膜混浊很常见。尽管存在这些挑战，但定期的术后随访和适当的处理有助于减轻并发症。术前光学相干断层扫描检查中椭圆体带和外界膜的完整性是白内障手术后视觉结果的主要预测指标；然而，结果可能会有所不同。虽然许多患者的视力有显著改善，但由于先前存在的晚期视网膜变性，一些患者可能受益有限。
白内障手术可能会给RP患者带来有意义的视力益处；然而，需要仔细的术前评估和精细的手术技术来应对可能的挑战。细心的术后护理和随访对于优化视觉结果至关重要。早期手术干预可以显著改善选定患者的生活质量，对于需要进行白内障手术的RP患者，需要采用量身定制的方法。进一步研究人工智能在监测术后恢复和检测并发症方面的潜在应用，可能会改善手术结果并提高患者护理水平。
