Background: Retinitis pigmentosa (RP) is associated with the development of posterior subcapsular cataract (PSC). Due to their retinal pathology, RP patients need optimal contrast conditions to attain good visual acuity. Lens opacities like PSC, therefore, decrease central visual acuity in RP patients earlier and more markedly than in patients without retinal problems.
Patients and methods: We examined 39 patients aged 52.2 +/- 15.4 years who had underwent 61 cataract operations with intraocular lens implantation 1-4 years previously. Patients with autosomal dominant (n = 7), autosomal recessive (n = 1), X chromosomal recessive (n = 2), and simplex RP (n = 21), as well as eight patients with Usher's syndrome (RP and sensoneurinal deafness), were evaluated.
Results: Visual acuity (VA) of all patients increased from 0.17 +/- 0.13 preoperatively to 0.33 +/- 0.22 postoperatively. The mean age of the patients at the onset of RP was 28.8 +/- 19.6 years. The average time between subjective onset of RP and cataract operation was 20 years. Patients with early manifestation of RP, before the age of 20 years, had significantly lower postoperative VA (P = 0.0005) than patients with late manifestation. A short duration of RP, less than 20 years, was associated with significantly better postoperative VA (P = 0.016). The surgical trauma of the cataract operation did not influence the course of RP. Visual field testing did not show statistically significant differences between preoperative and postoperative (1-4 years) results. The development of clinically significant posterior capsule opacification was observed in 70.7% of all RP patients.
Conclusions: Patients with RP and cataract should be operated early to provide, for as long as possible, an optimal optical image to compensate and support the inferior retinal function. Early onset of RP symptoms and longer duration of the disease have an negative impact on postoperative visual outcome in cataract surgery.