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Review
. 2022 Dec;11(6):1975-1989.
doi: 10.1007/s40123-022-00563-2. Epub 2022 Sep 4.

Effects and Prognosis of Cataract Surgery in Patients with Retinitis Pigmentosa

Hailong He  1   2 , Hao Song  1   2 , Xiaodie Meng  1   2 , Kai Cao  1 , Yi-Xin Liu  1   2 , Jinda Wang  1   2 , Xiuhua Wan  1   2 , Zi-Bing Jin  3   4
Affiliations
Review

Effects and Prognosis of Cataract Surgery in Patients with Retinitis Pigmentosa

Hailong He et al. Ophthalmol Ther. 2022 Dec.

Abstract

Introduction: Cataract extraction could improve visual acuity (VA) for patients with retinitis pigmentosa (RP), while the surgery may increase photoreceptor degeneration through light damage. In this study, we conducted a systematic review and meta-analysis to investigate the effectiveness and prediction of VA after cataract surgery in patients with RP.

Methods: We comprehensively extracted data from literature of available studies with quality control processing. Improvement of VA before and after cataract surgery of different durations of follow-up and different structural integrity of the preoperative macular ellipsoid zone (EZ) in patients with RP were compared. VA was measured by the logarithm of the minimum angle of resolution (logMAR).

Results: Sixteen studies were subjected to analysis. Postoperative VA was significantly improved versus preoperative, with a mean difference (MD) of 0.57 [95% confidence interval (CI) 0.45, 0.69], and a fixed-effect model was applied during follow-up durations of 1 day to 1 month (I2 = 0%). Similarly, for follow-up durations of 1-3 months, 3-6 months, and 6-12 months, postoperative VAs were all better than preoperative values, with MDs of 0.36 (95% CI 0.31, 0.41), 0.35 (95% CI 0.23, 0.46), and 0.22 (95% CI 0.14, 0.30) (I2 < 50%). For follow-up duration of 1-5 years, the random-effect model was applied for higher heterogeneity (I2 = 81%), with an MD of 0.26 (95% CI 0.09, 0.43). There was no significant difference in the improvement of the EZ-invisible group, with an MD of 0.27 (95% CI - 0.17, 0.70) (I2 = 82%). There were significant differences between EZ-abnormal and EZ-normal groups in preoperative and postoperative VA, with MDs of 0.56 (95% CI 0.27, 0.85) and 0.46 (95% CI 0.27, 0.65) (I2 > 50%).

Conclusions: Cataract surgery could improve VA for patients with RP during long-term follow-up, and the surgery is not recommended for patients with invisible preoperative macular EZ. However, further studies are required to address the problem of excessive light exposure to the degenerated retina in patients with RP with the cataract removed. The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022340165).

Keywords: Cataract surgery; Meta-analysis; Retinitis pigmentosa; Systematic review.

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Figures

Fig. 1
Fig. 1
Clinical presentations of a 47-year-old male patient. Manifestation of posterior subcapsular cataract, bone spicule pigmentation, and OCT showing abnormal ellipsoid zone
Fig. 2
Fig. 2
PRISMA flowchart of paper selection
Fig. 3
Fig. 3
Forest plot of improvement of VA during follow-up durations of (0,1] month
Fig. 4
Fig. 4
Forest plot of improvement of VA during follow-up durations of (1,3] months
Fig. 5
Fig. 5
Forest plot of improvement of VA during follow-up durations of (3,6] months
Fig. 6
Fig. 6
Forest plot of improvement of VA during follow-up durations of (6,12] months
Fig. 7
Fig. 7
Forest plot of improvement of VA during follow-up durations of (12,60] months
Fig. 8
Fig. 8
Summary results of improvement of VA during different durations of follow-up
Fig. 9
Fig. 9
Forest plot of changes of preoperative and postoperative VA in the EZ-invisible group
Fig. 10
Fig. 10
Forest plot of changes of preoperative and postoperative VA in the EZ-abnormal group
Fig. 11
Fig. 11
Forest plot of changes of preoperative and postoperative VA in the EZ-normal group
Fig. 12
Fig. 12
Summary results of changes of VA in each EZ grade
See this image and copyright information in PMC

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