Cataract surgery by phacoemulsification in adults with retinopathy of prematurity

PURPOSE: To report the preoperative, operative, and postoperative factors a ssociated with phacoemulsification cataract surgery in adults with retinopa thy of prematurity. METHODS: Records of patients with retinopathy of prematurity who underwent phacoemulsification at The Wilmer Institute between January 1990 and Januar y 2000 were retrospectively searched. Seventeen adults (9 women, 8 men) wit h retinopathy of prematurity were identified who had undergone phacoemulsif ication for visually significant cataract or phacomorphic glaucoma and who had at least 6 months of postoperative followup. RESULTS: Cataract extraction by phacoemulsification was performed on 20 eye s. Follow,up ranged from 6 to 103 months (mean, 32 months). A posterior cha mber intraocular lens was placed in 18 eyes; two eyes were left aphakic for refractive reasons. Zonular weakness was noted in two eyes in which the in traocular lens was suture fixated to the sclera. Concomitant trabeculectomy was performed in one eye. Visual acuity improved in 18 of 20 eyes and rema ined unchanged in two eyes. Postoperatively, visual acuity was worse than 5 /200 in two eyes, 5/200 to worse than 20/100 in five eyes, 20/100 to 20/50 in five eyes, and 20/40 or better in eight eyes. One eye developed a rhegma togenous retinal detachment I month after cataract surgery; the retina was successfully reattached. CONCLUSIONS: Although cataract extraction in eyes with regressed retinopath y of prematurity may present challenges, such as high myopia, monocularity, glaucoma, and previous ocular surgery, phacoemulsification in this series proved to be relatively safe as well as visually rehabilitating. The surgeo n should be aware of the special considerations in this population, alert t o potential zonular weakness intraoperatively, and careful of increased pos toperative risks, including retinal detach. ment. (Am J Ophthalmol 2001;132 :306-310. (C) 2001 by Elsevier Science Inc. All rights reserved.).