Cataract Surgery After Retinal Surgery – James S. Lewis, MD

Serving Philadelphia, Delaware Valley, Bucks County, Phoenixville, Montgomery County, Conshohocken and King of Prussia

Advances in retinal surgery have improved the prognosis of visual results in patients with retinal detachment, vitreous hemorrhage, diabetic retinopathy, and macular hole repair. We expect there will also be an increase in cataracts in patients with treatment for macular edema and age-related macular degeneration using anti-VEGF and intraocular steroid injections.

Total vitrectomies are commonly performed in modern retinal surgery. Unlike standard cataract surgery these eyes lack the stability and consistency afforded by a normal vitreous. Surgeons must be prepared to use a different set of skills when doing these cases.

The presence of a scleral buckle, posterior staphyloma, and high myopia not only make the procedures harder but they also make implant power calculations considerably more difficult. We utilize both ultrasonic and laser-based measurements to determine the appropriate intraocular lens. This includes verification of corneal power with RGP contact lens over-refractions, topography, wavefront assessment, and optical coherence tomography.

Retinal specialists often demand the use of non-silicone, large optic, intraocular lenses. Collamer has been shown to be extremely well tolerated in retinal cases and to provide excellent visibility if further retinal surgery is required.

When silicone oil is needed for retinal reattachment it can cause serious damage to the cornea and the intraocular lens. Also, calculations of intraocular lens power must be done with the understanding that ultrasonic energy travels more slowly in silicone. I began working on this problem with Robert Machemer, MD, the developer of modern pars plana vitrectomy, at Duke in 1984. He had asked for my help when I was an ophthalmology resident based on my mathematics background.

Cataract surgeons working with patients following retinal surgery should be capable of removing silicone oil. I have been removing silicone oil during cataract surgery for 3 decades and it is not nearly as easy as one might think. However, due to my extensive experience, I am able to consistently provide my Philadelphia / Bucks County cataract patients with excellent results.