title: Cataract extraction outcomes and the prevalence of zonular insufficiency in retinitis pigmentosa.
abstract: OBJECTIVE
  To examine surgical outcomes in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  In this single-institution study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012, preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium-aluminum-garnet (YAG) laser capsulotomy, and surgical complications.
  
  
  RESULTS
  Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range, 31-78 years). Mean follow-up time was 23.3 months (range, 1 day - 95 months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the minimal angle of resolution [logMAR] 1.23) to 20/129 (0.81) within 3 months of surgery, P < .0001. Eyes with a preoperative vision of 20/40 to 20/200 (47 eyes) improved from a mean of 20/81 (logMAR 0.61) preoperatively to 20/43 (0.33), P < .0001, postoperatively. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8 months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively, and 4 postoperatively). One patient had bilateral dislocated in-the-bag intraocular lenses at 5.5 years and 6 years after surgery.
  
  
  CONCLUSIONS
  Cataract surgery yields significantly improved Snellen visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuity of 20/400 or worse generally have more limited objective improvements, likely because of macular involvement, but usually report noticeable subjective improvement. A high prevalence of zonular instability is seen in RP patients undergoing cataract extraction. It is therefore important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
authors.forename: Mark Samuel
authors.initials: MS
authors.lastname: Dikopf
authors.forename: Clement Chikai
authors.initials: CC
authors.lastname: Chow
authors.forename: William Francis
authors.initials: WF
authors.lastname: Mieler
authors.forename: Elmer Yuchen
authors.initials: EY
authors.lastname: Tu
mesh_terms: D000328:Adult; D000368:Aged; D058442:Capsule Opacification / Q000209:etiology / Q000601:surgery; D002386:Cataract / Q000150:complications; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D053844:Lasers, Solid-State; D007905:Lens Diseases / Q000209:etiology*; D019654:Lens Implantation, Intraocular; D008022:Ligaments / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D015995:Prevalence; D012174:Retinitis Pigmentosa / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015354:Vision, Low / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology