A macula-off retinal detachment usually means a more limited visual prognosis because the critical central vision has been permanently altered from the event. However, in some cases there can be a remarkable recovery of vision. These patients often require a more complex retinal repair which includes a pars plana vitrectomy and injection of a gas bubble, both of which can induce a cataract.

This patient is younger and had a macula-off retinal detachment repaired about a year ago. The retina surgery was successful and the retina has remained attached and stable. A dense nuclear cataract developed in this eye and the vision declined to the Count Fingers level. He certainly could benefit from a cataract surgery, but we are not sure of the final visual potential which will be limited by the macular status.

What should we do differently in this case?

with a prior vitrectomy, we need to understand that the absence of the anterior hyaloid face means less central support for the cataract during phaco. Explained in this article/video.
we need to anticipate that the effective lens position may be deeper in the eye so we should add 0.5 D to the calculated IOL power to prevent a hyperopic surprise
the anterior capsular opening should be about 5 mm in diameter so that it overlaps the 6 mm optic of the IOL for 360 degrees. Previously demonstrated in this article/video.
ensure that the posterior capsule was not damaged during the prior retinal procedures. This is rare among experienced retina surgeons, but it can happen as shown in this article/video.

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