{"title":"视网膜色素变性的白内障手术。","authors":"Omer Karti, Ali Osman Saatci","doi":"10.51329/mehdiophthal1500","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"13 2","pages":"96-103"},"PeriodicalIF":0.0000,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347957/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cataract surgery in retinitis pigmentosa.\",\"authors\":\"Omer Karti, Ali Osman Saatci\",\"doi\":\"10.51329/mehdiophthal1500\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":36524,\"journal\":{\"name\":\"Medical Hypothesis, Discovery, and Innovation in Ophthalmology\",\"volume\":\"13 2\",\"pages\":\"96-103\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347957/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medical Hypothesis, Discovery, and Innovation in Ophthalmology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.51329/mehdiophthal1500\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.51329/mehdiophthal1500","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
背景:视网膜色素变性(RP)是一种遗传性视网膜营养不良症,其特征是由于感光细胞变性而导致进行性视力丧失。并发性白内障的形成,尤其是后囊下白内障(PSC),经常发生在视网膜色素变性患者身上,并加重视力损伤。白内障手术可以改善视力;但是,RP 所面临的特殊挑战需要特别考虑。本微型综述旨在全面概述与 RP 相关的白内障:通过 PubMed/MEDLINE,以 "白内障"、"白内障手术"、"囊样黄斑水肿"、"遗传性视网膜营养不良"、"色素性视网膜炎"、"后囊膜下白内障"、"后囊膜不透明"、"疣状软化 "和 "人工智能 "为关键词,对 1976 年 1 月至 2024 年 6 月期间的文献进行了全面回顾。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、患者随访和视觉效果。我们纳入了相关的综述文章、临床试验和病例报告以及这些文章的相关参考文献列表:结果:共详细研究了 53 篇文章,包括通过重点关键词搜索发现的文章和这些文章的参考文献目录。RP患者接受白内障手术后,视力通常会得到显著改善。然而,手术可能会变得复杂,尤其是晶状体的带状薄弱和半脱位。通过使用囊袋拉力环和细致的手术技巧可以降低这些风险。此外,囊样黄斑水肿和后囊不透明等术后并发症也很常见。尽管存在这些挑战,但术后定期随访和适当的管理有助于减少并发症。术前光学相干断层扫描检查显示的椭圆体区和外限界膜的完整性是预测白内障手术后视觉效果的主要指标,但结果可能各不相同。虽然许多患者的视力都有明显改善,但有些患者可能会因为已经存在晚期视网膜变性而获益有限:结论:白内障手术可为视网膜病变患者带来显著的视力改善,但需要仔细的术前评估和缜密的手术技巧来应对可能出现的挑战。术后精心护理和随访对优化视觉效果至关重要。对于需要进行白内障手术的 RP 患者来说,早期手术干预可以大大改善他们的生活质量。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,可能会改善手术效果并加强对患者的护理。
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.