AXIAL MYOPIA IS AN EXTREMELY SIGNIFICANT RISK FACTOR FOR YOUNG-AGED PSEUDOPHAKIC RETINAL DETACHMENT IN TAIWAN

PNEUMATIC RETINOPEXY: Analysis of Risk Factors and Complications in 850 Cases

BACKGROUND

To study out types and incidence of the complications and reveal the risk factors that affect anatomical and visual success of pneumatic retinopexy with a high number of rhegmatogenous retinal detachment cases.

METHODS

Eight hundred and fifty eyes of the 837 patients who admitted at a tertiary center, between January 2015 and January 2022 for the diagnosis of rhegmatogenous retinal detachment, then underwent pneumatic retinopexy and had at least sixth month follow-up, were included in the study. The multivariate logistic regression model was created to investigate the factors affecting anatomical and visual success.

RESULTS

The anatomical success rate was 53.4% with the first pneumatic retinopexy and 99.8% after subsequent procedures. Visual acuity of >0.4 logMAR (<20/50 Snellen), proliferative vitreoretinopathy, and macular involvement was determined as significant preoperative risk factors for single operation and visual success in all univariate and multivariate analyses. In addition, pseudophakic/aphakic lens status was associated with single operation failure in all analyses. Besides, in all analyzes for single operation and visual success, new or missed tears, proliferative vitreoretinopathy, delayed subretinal fluid, macular hole, and subretinal gas were identified as significant postoperative risk factors. Among these, new or missed tears was determined as the most common complication with a rate of 24%.

CONCLUSION

There are many risk factors influencing the success of pneumatic retinopexy. These factors and complications should always be considered, before applying this rapid, effective, inexpensive, and minimally invasive method.

Characteristics of pseudophakic retinal detachment and risk factors of recurrence

BACKGROUND

The present study was designed to gain knowledge about the prognostic factors and evolution of pseudophakic retinal detachment (PRD) and to analyse the main characteristics of PRD, such as the mean time to retinal detachment following cataract surgery, as well as the clinical factors associated with the risk of recurrence and worse anatomical and functional outcomes.

METHODS

This was a retrospective monocentric study of 330 patients with PRD who underwent surgery between 2012 and 2020. All patients were pseudophakic and were referred for retinal detachment surgery at Donostia University Hospital (Terciary Hospital, Spain).

RESULTS

The mean age of the patients at the time of phacoemulsification was 63.06 ± 10.8 years, and 49.09% of them had moderate myopia [axial length (AL) (23.5-26.5 mm)]. In our series, macular detachment was evident in 69.09% (n = 228) of the patients. The mean time that elapsed between phacoemulsification and PRD surgery was 4.04 ± 4.17 years, which was reduced by half in the event of surgical complications (2.24 ± 2.65). The rate of PRD was 28.79%. The anatomical results in terms of retinal reapplication were better with the combination of vitrectomy and scleral buckling (83.1% vs. 70.5%) (p = 0,127) compared with vitrectomy. The variables associated with a higher risk of recurrence were male sex (hazard ratio (HR) = 1.75), macular detachment (HR = 2.00) and the presence of proliferative vitreoretinopathy (PVR) (HR = 3.21).

CONCLUSIONS

PRD usually occurs within 4 years of phacoemulsification, although it may occur significantly earlier in the event of surgical complications. Macular involvement, PVR, and male sex are all associated with a higher risk of PRD recurrence.

Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study

PURPOSE

To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery.

DESIGN

Retrospective clinical database study.

METHODS

Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26).

MAIN OUTCOMES AND MEASURES

We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD).

RESULTS

Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different.

CONCLUSION

In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.

Effect of Nd: YAG laser capsulotomy on the risk of retinal detachment after cataract surgery: A systematic review and meta-analysis

ABSTRACT

We aimed to evaluate the impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy on the incidence of pseudophakic retinal detachment (RD). The PubMed and Embase databases were searched for meta-analysis. Subgroup analyses were conducted according to study location, number of cases, mean follow-up time, and cataract procedure. The final analysis included 11 studies with 309 cases of RD in 65,117 eyes undergoing cataract surgery. Among them, 8,232 eyes underwent Nd:YAG capsulotomy. Our analysis demonstrated an increased risk of RD with Nd:YAG laser capsulotomy (RR=1.57; 95%CI, 1.17-2.12; P=0.003; HR=1.64; 95%CI, 1.03-2.62; P=0.04). Subgroup analysis suggested somewhat stronger associations in Asian (RR=4.54; 95%CI, 2.20-9.38; P<0.0001) than in non-Asian populations (America, P=0.12; Europe and others, P=0.21), and with extracapsular cataract extraction (RR=2.97; 95%CI, 1.83-4.83; P<0.0001) than with phacoemulsification (P=0.95). To conclude, Nd:YAG laser capsulotomy may be associated with an increased risk of pseudophakic RD.

The incidence of rhegmatogenous retinal detachment is increasing

PURPOSE

To study the development over time of the age- and sex-standardized incidence of rhegmatogenous retinal detachment (RRD) in Denmark.

METHODS

Registry study, based on the Danish National Patient Registry data. End-point: Individuals undergoing the first surgery for RRD.

RESULTS

During 2000-2016 we identified 11 769 individuals with a primary RRD surgery in either eye. The age- and sex-standardized incidence rate of RRD increased by more than 50% during the study period. We found a significant increase in this incidence rate for both men and women older than 50 years, and in men, but not in women, younger than 50 years (p < 0.001). However, the increase of primary RRD surgery during the study period was most pronounced in men aged 50 years or older, where the rate of increase was 1.7 ± 0.1 cases per 100 000 person-years per year (p < 10^-11 ).

CONCLUSION

The incidence of RRD is increasing, and this increase is primarily driven by men aged 50 years or older.

Incidence of rhegmatogenous retinal detachment after bag-in-the-lens IOL implantation: extended follow-up in a larger cohort of patients

PURPOSE

To report the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique.

SETTING

Department of Ophthalmology, Antwerp University Hospital, Belgium.

DESIGN

Prospective cohort study.

METHODS

All consecutive BIL IOL surgeries performed between January 2001 and December 2010 were included, with the exclusion of combined procedures and IOL exchanges. The incidence of RRD was reported first in the total cohort, then in a subgroup of patients with 1 year to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors, except gender. Risk factors associated with RRD were examined using multiple Cox regression analysis with a random intercept.

RESULTS

Rhegmatogenous RD was diagnosed in 36 eyes (1.06%) of 3385 BIL cases, with a mean follow-up of 48.28 ± 40.05 months (range 0 to 195 months). The 2-year cumulative RRD incidence rate was 0.66% (17 cases in 1024 eyes; 0.00% in patients without risk factors). The 5-year cumulative RRD incidence rate was 1.17% (26 cases in 931 eyes; 0.15% without risk factors). Five risk factors were confirmed: male sex, age less than 60 years at the time of surgery, axial length 25.0 mm or greater, a history of contralateral RD, and intraoperative surgical complications.

CONCLUSIONS

The incidence of RRD after BIL IOL implantation is comparable with that of lens-in-the-bag (LIB) implantation. This larger study provided a longer follow-up and suggested that RRD incidence is even lower than that previously reported. This study also confirmed intraoperative surgical complications as an additional risk factor for RRD development, as already described with LIB implantation.

Retinal detachment following cataract phacoemulsification-a review of the literature

A link between cataract surgery and rhegmatogenous retinal detachment (RRD) has long been considered. Indeed, pseudophakic retinal detachment (PPRD) forms a substantial and increasing proportion of RRD. We reviewed the literature to answer the following questions: what is the incidence of PPRD in eyes following phacoemulsification cataract surgery and how does its risk change over time following surgery? We also sought to assess how the risk is modified by intraoperative factors (operative complications, surgeon grade, subsequent laser capsulotomy), intrinsic eye-related factors (laterality, myopia, previous RRD, previous trauma, previous PVD) and patient factors (sex, age, ethnicity, affluence, systemic comorbidities). Secondarily we asked how the incidence of PPRD after phacoemulsification compares with the RRD incidence in the general population and how identified risk factors contribute to the pathophysiology of PPRD. A search of the Medline and Ovid databases was conducted for relevant publications from 1990 onwards using defined search terms with pre planned inclusion and exclusion criteria. The 10-year PPRD incidence after phacoemulsification was identified as being between 0.36 and 2.9%. This decreases over time to 0.1-0.2% annually but remains above the general population. The PPRD risk is further elevated by (in order of decreasing effect) intraoperative vitreous loss, increasing axial length, younger age, male sex and trainee operating surgeons. The PPRD risk after phacoemulsification is approximately ten times the general population's RRD risk. This risk is modified by the interplay of a hierarchy of risk factors, of which intraoperative vitreous loss, myopia, age and sex have the biggest effect.

Pseudophakic retinal detachment in young-aged patients

Objective

To investigate the incidence and risk factors for retinal detachment (RD) after cataract surgery or refractive lens exchange (RLE) in patients aged below 61 years.

Methods

Retrospective medical chart review of 7,886 patients (13,925 eyes) who underwent cataract surgery or RLE. Patients aged below 61 years were selected. Age, gender, axial length, follow-up times, and the occurrence of RD were recorded. Additional characteristics documented for RD cases were: history of RD, preexisting retinal findings, laser capsulotomy, status of macula at RD, date and details of RD.

Results

From a total of 421 patients (677 eyes) aged below 61 years 24 cases of RD were identified, resulting in an overall cumulative incidence per eyes of 3.55%. The mean follow-up time was 45 ± 32.8 months. Ninety-two % of all RDs occurred within 3.6 years from surgery. Axial length had a significant effect on the risk of RD after cataract/ RLE surgery (HR = 1.42, P = 0.0001, 95% CI 1.19–1.69). The highest incidence of RD occurred in the subgroup of 25 to 28.9 mm axial length (10.2%). With an increase in age of ten years, the hazard of postoperative RD was not significantly increased by a factor of 1.50 (P = 0.286, 95% CI 0.71–3.15). The highest incidence of RD occurred in patients aged 50–54 years (5.39%). Compared to females, males had an almost twofold not significant risk of postoperative RD (HR = 1.96, P = 0.123, 95% CI 0.83–4.63). None of the RD cases had a history of RD.

Conclusions

Axial length is a significant risk factor for pseudophakic RD. The need for cataract surgery or RLE should be carefully considered in patients with axial lengths between 25 and 29 mm, aged 50–54 years, in males, and in case of preexisting retinal findings.

Peripheral Retinal Vascular Patterns in Patients with Rhegmatogenous Retinal Detachment in Taiwan

This is an observational study of fluorescein angiography (FA) in consecutive patients with rhegmatogenous retinal detachment (RRD) in Changhua Christian Hospital to investigate the peripheral retinal vascular patterns in those patients. All patients had their age, sex, axial length (AXL), and refraction status (RF) recorded. According to the findings in FA of the peripheral retina, the eyes were divided into 4 groups: in group 1, there was a ramified pattern of peripheral retinal vasculature with gradual tapering; in group 2, there was an abrupt ending of peripheral vasculature with peripheral non-perfusion; in group 3, there was a curving route of peripheral vasculature forming vascular arcades or anastomosis; and in group 4, the same as in group 3, but with one or more wedge-shaped avascular notches. Comparisons of age, sex, AXL, and RF, association of breaks with lattice degeneration and retinal non-perfusion, surgical procedures utilized, and mean numbers of operations were made among the four groups. Of the 73 eyes studied, there were 13 eyes (17.8%) in group 1, 3 eyes (4.1%) in group 2, 40 eyes (54.8%) in group 3 and 17 eyes (23.3%) in group 4. Significant differences in age, AXL and RF, and association of retinal breaks to non-perfusion were noted among the four groups. Patients in group 1 had older ages, while younger ages were noted in groups 3 and 4. Eyes in group 1 had the shortest average AXL and were least myopic in contrast to the eyes in groups 3 and 4. Association of retinal breaks and retinal non-perfusion was significantly higher in groups 2, 3 and 4 than in group 1. In conclusion, peripheral vascular anomalies are common in cases with RRD. Patients with peripheral non-perfusion tend to be younger, with longer axial length and have the breaks associated with retinal non-perfusion.

Risk factors for retinal detachment following cataract surgery: the impact of posterior capsular rupture

AIM

To investigate risk factors for retinal detachment (RD) after cataract surgery, particularly posterior capsular rupture (PCR) with or without vitreous loss.

METHODS

Single centre electronic medical record database study of 18 065 consecutive first eye cataract operations performed between 2005 and 2014. Survival analysis was performed with Kaplan-Meier curves and a Cox proportional hazard regression analysis to calculate HRs with respect to RD.

RESULTS

The RD rate at 3 months and 7 years was 0.067% and 0.30%, respectively, with a median time to RD of 15 months (mean: 18 months, range: 0-84 months). Men had a higher RD risk (HR 2.00; 95% CI 1.03 to 3.88; p=0.03) in the univariate model. Patients <60 years and those >80 years had an HR of 5.12 (95% CI 2.60 to 10.07; p<0.001) and 0.16 (95% CI 0.38 to 0.69; p=0.01), respectively, compared with patients 60-80 years of age. Eyes longer than 25 mm had an HR of 3.98 (95% CI 1.93 to 8.20; p<0.001) compared with eyes 23-25 mm. PCR occurred in 400 (2.2%) eyes. The HR for RD was 12.83 (95% CI 5.62 to 29.30; p<0.001) for PCR with vitreous loss. There were no RD events in eyes with PCR without vitreous loss.

CONCLUSIONS

The risk for RD after cataract surgery is higher in younger patients and eyes with longer axial length or PCR with vitreous loss during surgery.

Incidence of rhegmatogenous retinal detachment after bag-in-the-lens intraocular lens implantation

PURPOSE

To determine the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after phacoemulsification and bag-in-the-lens intraocular lens (IOL) implantation.

SETTING

Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium.

DESIGN

Prospective cohort study.

METHODS

All consecutive bag-in-the-lens IOL implantations performed between January 2001 and December 2007 were included, with the exception of combined procedures and IOL exchanges. The retinal detachment (RD) incidence was studied in the total cohort, in a subgroup of patients with 1 to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors except gender.

RESULTS

RD after bag-in-the-lens IOL implantation in 1323 eyes with an average follow-up of 44.75 months (range 0 to 152 months) was found in 19 eyes (1.44%). The 1-year RD incidence was 0.49% (5 RD cases in 1024 eyes) (0.00% in patients without risk factors). The 2-year cumulative RD incidence was 0.84% (9 RD cases in 931 eyes; 0.15% without risk factors). Four clinically significant risk factors were confirmed: male gender, young age at time of surgery (<60 years), axial myopia (axial length ≥25 mm), and history of contralateral RD in the total cohort.

CONCLUSION

The RRD incidence following bag-in-the-lens IOL implantation was comparable to that seen after lens-in-the-bag (LIB) implantation. The wide variation in study design in the literature precludes direct comparison, so there is a need for standardization in evaluating RRD incidence after cataract surgery. Future prospective studies should consider patients with and without risk factors (except gender) separately.

FINANCIAL DISCLOSURE

Prof. dr. M.J. Tassignon has intellectual property rights to the bag-in-the-lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794; PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany.

Macular parameters of Stratus optical coherence tomography for assessing glaucoma in high myopia

BACKGROUND

The aim was to assess the macular parameters of glaucoma in highly myopic subjects.

METHODS

In a retrospective study, we enrolled 72 highly myopic eyes (spherical equivalent up to -6.00 D), of which 31 had early to moderate glaucoma and 41 formed a control group. The diagnosis of early to moderate glaucoma was based on glaucomatous visual-field defects with a mean deviation better than -12 dB. All patients underwent imaging with Stratus optical coherence tomography. We subsequently performed analysis for macular volume and thickness parameters between two groups.

RESULTS

Using Stratus optical coherence tomography, we found significantly lower values in both macular thickness and volume over outer superior, outer nasal, outer inferior, inner temporal and inner inferior regions in highly myopic eyes with early to moderate glaucoma than in the control group. The macular outer inferior average thickness, macular outer inferior average volume and total average macular volume on Stratus optical coherence tomography had a best combination of sensitivity and specificity (85.4 and 74.2 per cent, respectively). The outer inferior average volume and outer inferior average thickness parameters showed areas under the receiver operating characteristic curve value of 0.85 (95% CI 0.76 to 0.94), which were best for discriminating between early to moderate glaucoma and the control group.

CONCLUSION

Using Stratus optical coherence tomography, the outer inferior macular volume is the only independent predictor for detecting early to moderate glaucoma in high myopia. The macular outer inferior thickness and volume parameters showed good sensitivity, specificity and area under the receiver operating characteristic curve. These parameters may provide a complementary glaucomatous diagnosis in highly myopic eyes.

Late increased risk of retinal detachment after cataract extraction

PURPOSE

To identify the possibility and characteristics of late increase in the cumulative risk of retinal detachment (RD) after cataract extraction and intraocular lens (IOL) implantation.

DESIGN

Prospective cohort study of submitted claims records.

METHODS

Records of 9388 consecutive insurance beneficiaries who underwent cataract extraction and IOL implantation between August 1, 1999 and December 1, 2001 were collected from the Bureau of National Health Insurance. Data included each patient's demographic characteristics, medical history, refractive status, axial length (AL), type of cataract extraction, and intraoperative complications. Posterior capsulotomy, diagnostic procedures, and treatment for retinal complications and other ocular diseases were identified by codes from physicians' billing records yearly to the end of 2007.

RESULTS

The cumulative 8-year RD rate was 2.31% at the end of the follow-up. Factors with significant effect on the risk of RD included being male and younger, having an increased AL, and having a history of RD in the fellow eye. The cumulative risk of RD after cataract extraction and IOL implantation increased with time. There was a significantly late increased risk of RD after 4 years in the group of patients with high myopia (AL, > 26 mm; P = .026), but not in the group of moderate myopia (AL 23 to 26 mm, P = .068) or nonmyopia (AL, < 23 mm; P = .066). The late increase appeared in male group, but not in the female group, even in those with high myopia (male, P = .042; female, P = .068).

CONCLUSIONS

Our study showed that patients with high myopia may be at increased risk for late pseudophakic RD after 4 years, especially in males.

Male Sex as a Risk Factor for Pseudophakic Retinal Detachment after Cataract Extraction in Taiwanese Adults

PURPOSE

To investigate the role of sex in modifying risk factors for retinal detachment (RD) after cataract surgery.

DESIGN

Prospective cohort study based on medical records and insurance claims from Taiwan's Bureau of National Health Insurance (BNHI).

PARTICIPANTS

Nine thousand three hundred eighty-eight patients who underwent extracapsular cataract extraction (CE), including phacoemulsification procedures, between August 1999 and December 2001.

METHODS

Medical charts and claims submitted by insurance beneficiaries who underwent CE and intraocular lens implantation were collected from the sixth branch of the BNHI. Data recorded for analysis included each patient's demographic characteristics, medical history, refractive status, axial length (AL), type of CE, and intraoperative complications. Posterior capsulotomy, diagnostic procedures, and treatments for retinal complications and other ocular diseases were identified on the basis of codes from physicians' billing records at the end of 2005.

MAIN OUTCOME MEASURES

Incidence of RD in the full study group and in subgroups defined by sex, age, AL, type of CE procedure, concurrent systemic diseases, presence of intraoperative complications, and subsequent posterior capsulotomy.

RESULTS

The mean follow-up time of patients at the time of analysis was 54.99+/-15.53 months. The rate of lost follow-up was 11.55%. Cumulative 6-year RD rates were 1.16% in the full study group, 1.90% in the male subgroup, and 0.56% in the female subgroup at the end of the follow-up period. Gender distribution had a significant influence on the occurrence of RD after CE (P<0.001). Factors that were found to have a significant effect on the risk of pseudophakic RD included age under 50 years (P = 0.002), AL (P<0.001), and history of RD (P = 0.003). Surgical types (extracapsular vs. phacoemulsification) were not correlated significantly with RD, and neither were such systemic diseases as diabetes and hypertension. Subgroup analysis indicated that the significance of age, AL, and history of RD as risk factors persisted in the male subgroup but not in the female subgroup.

CONCLUSIONS

The impact of axial myopia, age, and RD history as risk factors for pseudophakic RD was seen predominantly in males.

Assessment of macular retinal thickness and volume in normal eyes and highly myopic eyes with third-generation optical coherence tomography

PURPOSE

To compare the macular retinal thickness and macular volume between subjects with high myopia and non-myopia.

METHODS

This prospective nonrandomized, comparative study recruited healthy subjects with high myopia subjects, defined as a spherical equivalence (SE) over -6 dioptres (D) or AXL>or=26.5 mm and the best corrected visual acuity better than 20/25, and subjects with non-myopia, defined as an with SE between 1.5D and -1.5 D and the BCVA better than 20/25. Optical coherence tomography was performed in each eye.

RESULTS

Eighty high myopic eyes and 40 non-myopic eyes were included. The mean age of the high myopic group and non-myopia group was 29.6 and 27.5 years old, respectively. The mean refraction was -9.27 D in the high myopia group and -0.22 D in the non-myopia group. The high myopia group had significantly greater mean retinal thickness in the foveola and fovea 1 mm area than the non-myopia group (166 vs149 microm, P<0.0001, 199 vs188 microm, P=0.0063, respectively). However, the mean retinal thickness in the inner and outer macular area (superior, nasal, inferior, or temporal) of the high myopia group was significantly less than in the non-myopia group. In addition, the high myopia group had significantly smaller macular volume than the non-myopia group (P<0.0001).

CONCLUSION

This study demonstrated that the retinal thickness in individuals with high myopia is thicker in the foveola and fovea, but thinner in the inner and the outer macular region. The retina of individuals with high myopia had smaller macular volume than those with non-myopia.