Retinal diseases, such as Fuchs’ dystrophy, glaucoma, macular degeneration, diabetic retinopathy or uveitis, often co-exist with cataracts. These corneal problems can affect the effectiveness of the IOL that is implanted and negatively impact vision quality post-surgery. In some instances, cataract surgery can worsen other retinal conditions.
Cataract surgery can also be more challenging if the patient has undergone previous eye surgery for other issues, such as vitrectomy, a glaucoma shunt implantation or scleral buckling.
Cataracts and macular degeneration are common eye conditions that affect older patients and often co-exist. There have been some studies to suggest that cataract surgery can worsen macular degeneration, but most major studies have found no link.
Often severe cataracts can mask the development of macular degeneration and once vision quality is improved post-cataract surgery, the patient may then notice distortion due to macular degeneration and believe it’s a result of the surgery.
Advanced macular degeneration affects the central vision and removing cataracts can greatly improve the quality of peripheral vision for patients and generally improve their quality of life.
Meticulous pre-operative planning is essential. I will carefully assess all corneal issues pre-operatively.. Salzmann’s nodular degeneration (SND) is a progressive condition that can make the appropriate IOL selection more challenging and may cause irregular astigmatism. Removal of the nodules prior to cataract surgery may be advised.
Post-surgical planning is also an essential component of managing retinal diseases with cataract surgery. Fuchs’ dystrophy is an inherited problem which affects the cornea, or front part of the eye. It affects the pump layer of cells that pump fluid back into the eye and if they aren’t functioning properly the cornea can become cloudy – patients often find their vision is misty when waking although it typically then clears.
As both Fuchs’ dystrophy and cataracts tend to develop as you get older, they often co-exist. Some patients may need corneal transplantation after cataract surgery. The damaged endothelial layer is replaced with healthy tissue in a Descemet Membrane Endothelial Keratoplasty (DMEK) procedure.
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