CATARACT-EXTRACTION IN EYES WITH DIABETIC IRIS NEOVASCULARIZATION

BACKGROUND AND OBJECTIVE: Iris neovascularization used to be considere d a strict contraindication to intraocular surgery, especially intraoc ular lens implantation. In this study, the authors analyzed whether ca taract extraction and posterior chamber lens implantation is associate d with unacceptable intraoperative and early postoperative complicatio ns in patients with proliferative diabetic retinopathy and rubeosis ir idis. PATIENTS AND METHODS: Using a computerized data retrieval system , the authors identified all the patients with manifest iris neovascul arization and proliferative diabetic retinopathy who underwent catarac t extraction in their institution between 1989 and 1995. The preoperat ive, intraoperative, and early postoperative data were analyzed retros pectively with regard to complications and visual results. RESULTS: Th irty-nine eyes of 33 patients (mean age 64.6 +/- 10.9 years) with mani fest pupillary rubeosis iridis were analyzed. All but 3 of the eyes ha d undergone previous retinal laser treatment, with dense cataracts pre venting additional photocoagulation. Additional chamber angle neovascu larization was present in 11 eyes. Posterior chamber intraocular lense s were implanted in 35 eyes. Intraoperatively, iris hemorrhage was not ed in 10 eyes and was significantly more frequent in eyes that underwe nt nuclear expression (50%) than in those that underwent phacoemulsifi cation (12%; P = .019). Postoperatively, spontaneously resolving hyphe ma was observed in 7 eyes as well as reversible fibrin formation in 6 eyes. No severe sight-threatening complications occurred. Visual acuit y improved in 33 (85%) of the eyes. CONCLUSION: Cataract extraction wi th posterior chamber lens implantation does not appear to be associate d with unacceptable intraoperative or early postoperative complication s. However, adequate treatment of underlying diabetic retinopathy prio r to cataract extraction (and if necessary, postoperatively) is essent ial to prevent the progression of retinal and iris neovascularization.