Cataract Outcomes Following Scleral Buckle Surgery for Retinal Detachment

Abstract

Purpose

To investigate refractive, visual, and safety outcomes of cataract surgery performed after scleral buckling (SB) for retinal detachment (RD).

Patients and methods

A chart review at an academic medical center identified eyes with history of SB followed by subsequent cataract extraction between 2010 and 2022. Eyes with less than 3 weeks follow-up, silicone oil at time of biometry measurement, previous cornea surgery, or co-existing pathology impacting refractive outcomes were excluded. Predicted postoperative spherical equivalents (SE) were calculated with the Barrett Universal II (BU2), Kane, and SRK/T formulas for the implanted intraocular lens (IOL), and complications occurring within 1 year of surgery were abstracted.

Results

Sixty eyes of 60 patients met criteria for inclusion, and 40 (66.7%) had postoperative refraction recorded. Absolute prediction errors were 0.49, 0.45, and 0.52D with BU2, Kane, and SRK/T, respectively. Actual postoperative refraction was within 0.5 and 1.0 D of predicted in 26 (65.0%) and 36 (90.0%) using BU2, 23 (58%) and 37 (93%) using Kane, and 21 (52.5%) and 36 (90.0%) using SRK/T. In eyes with macula-on RD, corrected distance visual acuity (CDVA) of logMAR 0.301 (≈20/40) and logMAR 0.544 (≈20/70) or better was achieved in 12 (75.0%) and 15 (93.8%) of eyes. For macula-off RD eyes, these proportions were 19 (63.3%) and 24 (80.0%), respectively. Posterior capsular opacification requiring Nd: YAG capsulotomy was the most frequent complication in 30 (56.7%) eyes.

Conclusion

Refractive outcomes of cataract surgery following SB may be modestly reduced, even when using modern formulas. Nevertheless, cataract surgery in this population results in favorable visual outcomes.

Plain Language Summary

The retina is the part of the eye that is responsible for converting incoming light into a signal that the brain can interpret. A retinal detachment is an emergent condition in which the retina is torn away from its normal position. Scleral buckling is one method of surgically reattaching the retina. Although quite successful, scleral buckling can cause changes to the shape of the eye, and also increases the risk of opacification of the natural lens of the eye, otherwise known as a cataract. The purpose of this study is to investigate the outcomes of cataract surgery in eyes with prior scleral buckle surgery. The results show that despite advancements in methods of measuring the shape of the eye, calculating the appropriately powered IOL to implant, and surgical technique, cataract surgery in eyes with prior scleral buckling may result in poorer outcomes compared to eyes with no history of scleral buckling.

Keywords:

• Barrett Universal II
• cataract surgery
• refractive outcomes
• SRK/T
• scleral buckle
• retinal detachment

Data Sharing Statement

Data supporting the results can be obtained upon request to the corresponding author.

Acknowledgments

This paper was presented in part at the Association of Research and Vision (ARVO) in Ophthalmology, New Orleans, LA, April 2023. The abstract of this paper was presented in part at the Association for Research in Vision and Ophthalmology 2023 conference as a poster with interim findings. The poster’s abstracts were published in “Poster Abstracts” in Investigative Ophthalmology & Visual Science: Complications of Cataract Surgery in Eyes With History of Scleral Buckling & Refractive Outcomes of Cataract Surgery in Eyes with Prior Scleral Buckling.

Disclosure

Author ND is supported by the Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship. Dr Seth Pantanelli reports grants from Alcon, grants, personal fees from Bausch & Lomb, grants, personal fees from Carl Zeiss Meditec, personal fees from Hoya Surgical Optics, during the conduct of the study; grants from Alcon, grants from Bausch and Lomb, personal fees from Bausch and Lomb, grants from Carl Zeiss Meditec, personal fees from Carl Zeiss Meditec, personal fees from Hoya Surgical Optics, outside the submitted work. The authors report no other conflicts of interest in this work.