Retinal surprised after cataract surgery: retinitis pigmentosa sine pigmento

Author: Isabel Sendino-Tenorio (Spain)

Co-authors: Laura Monje-Fernandez, Carlos Plaza-Laguardia, Amancia Mateos-Hernandez, Felipe Costales-Mier, Irene Garzo-Garcia, Esteban Pertejo-Fernandez

Purpose

To describe a case of retinitis pigmentosa sine pigmento undiagnosed before to cataract surgery. With this case we would like to highlight the importance of optical coherence tomography (OCT) to identify occult macular or retinal diseases preoperatively in patients scheduled for routine cataract surgery.

Setting/Venue

Complejo Asistencial Universitario de León

Methods

Case report

Results

A 76-year-old caucasian woman who has had bilateral cataract surgery without any complications. Before the phacoemulsification, her best corrected visual acuity (BCVA) was 20/63 in her right eye (OR) and 20/40 in her left eye (OS), fundus examination revealed normal optic disc and macula appearance in both eyes. The BCVA after the surgery was 20/25 and 20/20 in OR and OI respectively. Two months after the surgery, she complained of difficulty to go down the stairs. The BCVA was the same and the funduscopy was between normal limitis. We performed an OCT and autofluorescence. The OCT showed a decreased thickness of the outer nuclear layer (ONL) and loss of the external limiting membrane (ELM) and ellipsoid zone (EZ). In the autofluorescence we found an hyperfluorescence perifoveal ring and motted hypofluorescence lesions along the periphery of the arcades. A visual field test was performed, it showed a residual central visual field with a small peripheral island. Retinal multimodal imaging helped in the correct diagnosis of retinitis pigmentosa sine pigmento.

Conlusions

Studies in patients with cataract but no clinically detectable retinal disease have shown that routine use of OCT prior to cataract surgery can detect subtle macular or retinal diseases, which may alter the course of treatment or lead to modification of consent. The routine use of OCT has been especially useful in patients being considered for advanced technology intraocular lenses as subtle retinal disease can be a contraindication to the use of these lenses. Other technologies that assess retinal function rather than structure, such as perimetry and electroretinogram can be used. In Retinitis Pigmentosa Sine Pigmento, the OCT and autofluorescence are very useful to view lesions that are hidden.

Financial Disclosure

NO

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