Cataract surgery in patient with macular pathology

Abstract

Macular edema is a common cause of poor visual acuity after cataract surgery in diabetics. Because it is difficult to discern between diabetic maculopathy and pseudophakic CME (Irvine-Gass syndrome) in postoperative cataract patients, it is important for ophthalmologists to understand the natural history of macular edema after cataract surgery in order to treat the condition adequately. The most accepted explanation for the pathophysiology of CME after surgery is inflammation in the anterior segment associated with disruption of the BAB, releasing mediators, particularly prostaglandins, that diffuse posteriorly leading to breakdown of the BRB and consequent macular edema. Managing post-cataract surgery inflammation are based on the premise that the prevention of inflammation should be the main goal. It is mandatory to perform good patient selection and correct eye/patient preparation according to the possible risk factors. Although the treatment options depend on the underlying cause of CME, the usual therapeutic approach for prophylaxis and treatment of CME is directed towards blocking the inflammatory mediators, mainly the prostaglandins in the anterior segment of the eye, using topical steroids and NSAIDs. There are several scenarios in which cataract surgery might worsen the progression of AMD. Cataract and AMD share common risk factors, such as smoking and nutrition, that could cause them to progress simultaneously. In addition, inflammatory factors have been implicated in the causation of AMD and it is feasible that inflammation occurring after cataract surgery could cause worsening of macular degeneration. Moreover, the replacement of the natural lens with an artificial lens could be associated with increased exposure to light and damaging ultraviolet rays. Clinicians who believe that cataract surgery increases the risk of AMD worsening may discourage cataract surgery despite visual loss and lens opacity.