In the past two decades, there have been tremendous advances in cataract surgery. Better technology and greater proficiency allow safer and faster surgery, with better visual outcomes and shorter recovery times. And a more active and optically demanding aging population has led to the increased need for cataract surgery.
One population-based study of the elderly in the United States found a dramatic linear increase in the rate of cataract surgery in the past 25 years.
Despite this good news about cataract surgery, there is a growing awareness of the effect of cataract surgery on a range of preexisting retinal pathology, and the decision to perform cataract surgery in eyes with preexisting retinal disease is often challenging.
Arguing for the removal of cataracts is the obvious fact that their presence can dramatically impair the patient’s vision and, for the physician, can hinder the visualization and management of underlying retinal pathology.
Likewise, the ability to use optical coherence tomography for evaluating retinal thickness—a mainstay in today’s management of many retinal diseases—can be markedly hindered by certain types of cataract. But cataract surgery can exacerbate retinal disease, and, ironically, some treatments for retinal disease, like intravitreal corticosteroids and pars plana vitrectomy, can themselves cause cataracts.
This article will review recent evidence on the relationship between cataract surgery and some of the most common retinal diseases, namely, age-related macular degeneration, diabetic retinopathy, retinal vein occlusion (RVO), epiretinal membrane and vitreomacular traction, and it will discuss some perioperative measures that can enhance surgical outcomes.
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