Posterior segment causes of reduced visual acuity after phacoemulsification in eyes with cataract and obscured fundus view

Abstract

Hisham M Jammal,1,3 Yousef Khader,2 Riham Shawer,3 Muawyah Al Bdour41Department of Ophthalmology, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Ophthalmology, King Abdullah University Hospital, Irbid, Jordan; 4Department of Ophthalmology, The University of Jordan, Amman, JordanPurpose: To determine posterior segment causes of reduced visual acuity after phacoemulsification in eyes with cataract and obscured fundus view.Patients and methods: Retrospective review of medical records of patients with cataract, obscured fundus view, and normal B-scan ultrasonography, undergoing phacoemulsification from May 2005 to March 2012 was conducted. Eyes with fundus pathology, previous trauma, surgery, glaucoma, amblyopia, or uveitic cataract were excluded. Ocular comorbid conditions, preoperative visual acuity (VA), intraoperative and early postoperative complications, and final best corrected visual acuity (BCVA) at 1 month were abstracted from the records.Results: All 201 eyes of 179 patients studied had a preoperative VA of ≤6/60. Preoperative ocular comorbidity was present in 31 eyes (15.5%). Intraoperative complications occurred in 20 eyes (10%). Postoperative complications developed in 34 eyes (17.0%). One month postoperatively, 175 eyes (87.1%) achieved a BCVA of ≥6/12; whereas 26 eyes (12.9%) achieved a BCVA of ≤6/18. The most common posterior segment causes of reduced VA in the 26 eyes were age-related macular disease in ten eyes (38.5%) and diabetic maculopathy in six eyes (23.1%). Similar fundus pathology was seen preoperatively in the fellow fundus in 10 of the 26 eyes (38.5%).Conclusion: One month after phacoemulsification in eyes with cataract and obscured fundus view, age-related macular disease and diabetic maculopathy were the most common posterior segment causes of reduced final BCVA. To avoid postsurgical dissatisfaction, patients with obscured fundus view in their preoperative eye should be counseled, especially if posterior segment pathology exists in their fellow eye.Keywords: B-scan ultrasonography, fundus view, macula, outcome, phacoemulsifcation