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Retinitis Pigmentosa
RETINITIS PIGMENTOSA
letters to the editor
To the Editor: I have a patient whose case history is relevant to Dr. Hull's letter concerning intraocular lens surgery in a patient with retinitis pigmentosa (Am Intra-Ocular Implant Soc] 4:208, 1978). This 52-year-old Caucasian lady had advanced retinitis pigmentosa with angle glaucoma and congenital cataracts at the time of her first examination. Subsequently, she developed increasing cortical changes which brought her to cataract surgery. In January 1975 she had an intracapsular cataract extraction done in her right eye. Despite a best-corrected vision of 20/50 with a soft contact lens, she was not happy because of the need for contact lens care and manipulation. She insisted on an intracapsular cataract extraction in the left eye with simultaneous insertion of an iris plane (Copeland) lens. Following a slightly stormy course of iritis and transient secondary glaucoma, she achieved 20/30+ with an overcorrection in the left eye. She subsequently insisted on a secondary implant in the right eye, and in April 1977 a McGhan Choyce-style intraocular lens was implanted. Her ultimate visual acuities are as good as those she experienced during her early years, prior to increasing opacification of her congenital cataracts. Her glaucoma has not proved difficult to control and she is happy with her vision. Solomon Liebowitz, M.D. New York, NY
Editor's note: This section is an open forum; opinions presented are not necessarily those of AIOIS.
To the Editor: In reference to Dr. Hull's letter, many patients suffering from retinitis pigmentosa can lose central vision from development of cystoid macular edema. Prior to removing the cataract in treatment of central vision reduction, I suggest using fluorescein angiography to make certain that the patient is not suffering from cystoid macular edema associated with retinitis pigmentosa. If this is the case then removing the crystalline lens probably will not increase central vision, and the aphakic state may exacerbate the macular edema. In addition, prior to considering removal of the cataract in an eye with retinitis pigmentosa, I would weigh the possibility of postoperative aphakic macular edema and subsequent reduction in central vision against the present preoperative visual acuity. Howard C. Joondeph, M.D. Grosse Pointe Park, MI
144
AM INTRA-OCULAR IMPLANT SOC J-VOL. V, APRIL 1979
letters to the editor
To the Editor: I have a patient whose case history is relevant to Dr. Hull's letter concerning intraocular lens surgery in a patient with retinitis pigmentosa (Am Intra-Ocular Implant Soc] 4:208, 1978). This 52-year-old Caucasian lady had advanced retinitis pigmentosa with angle glaucoma and congenital cataracts at the time of her first examination. Subsequently, she developed increasing cortical changes which brought her to cataract surgery. In January 1975 she had an intracapsular cataract extraction done in her right eye. Despite a best-corrected vision of 20/50 with a soft contact lens, she was not happy because of the need for contact lens care and manipulation. She insisted on an intracapsular cataract extraction in the left eye with simultaneous insertion of an iris plane (Copeland) lens. Following a slightly stormy course of iritis and transient secondary glaucoma, she achieved 20/30+ with an overcorrection in the left eye. She subsequently insisted on a secondary implant in the right eye, and in April 1977 a McGhan Choyce-style intraocular lens was implanted. Her ultimate visual acuities are as good as those she experienced during her early years, prior to increasing opacification of her congenital cataracts. Her glaucoma has not proved difficult to control and she is happy with her vision. Solomon Liebowitz, M.D. New York, NY
Editor's note: This section is an open forum; opinions presented are not necessarily those of AIOIS.
To the Editor: In reference to Dr. Hull's letter, many patients suffering from retinitis pigmentosa can lose central vision from development of cystoid macular edema. Prior to removing the cataract in treatment of central vision reduction, I suggest using fluorescein angiography to make certain that the patient is not suffering from cystoid macular edema associated with retinitis pigmentosa. If this is the case then removing the crystalline lens probably will not increase central vision, and the aphakic state may exacerbate the macular edema. In addition, prior to considering removal of the cataract in an eye with retinitis pigmentosa, I would weigh the possibility of postoperative aphakic macular edema and subsequent reduction in central vision against the present preoperative visual acuity. Howard C. Joondeph, M.D. Grosse Pointe Park, MI
144
AM INTRA-OCULAR IMPLANT SOC J-VOL. V, APRIL 1979