Retinal detachment in aphakia

Pseudophakic retinal detachment

Pseudophakic retinal detachment is a rare, but potentially serious, complication of cataract surgery. The incidence of pseudophakic retinal detachment following current surgical techniques of cataract extraction, including extracapsular cataract extraction by nuclear expression and phacoemulsification, is lower than that found after intracapsular cataract extraction. The risk of pseudophakic retinal detachment appears to be increased in myopic patients, in those patients in whom vitreous loss had occurred at the time of cataract surgery, and in patients undergoing Nd:YAG posterior capsulotomy. Most cases present to the clinician when the macula is already detached and the central vision is affected. When evaluating patients with pseudophakic retinal detachment, the fundal view is often impaired by anterior or posterior capsular opacification, reflections related to the intraocular lens, or poor mydriasis. Scleral buckling, pneumatic retinopexy, and primary pars plana vitrectomy, with or without combined scleral buckling, are the surgical techniques used to treat pseudophakic retinal detachment. Anatomical success rates are high after vitreo-retinal surgery for pseudophakic retinal detachment, although a smaller proportion of patients recover good vision following surgery.

Bilateral acute postoperative retinal detachment after cataract extraction: case report and review of the literature

A 57-year-old white man had extracapsular cataract extraction complicated by vitreous loss. On postoperative day 1, he was noted to have a total retinal detachment (RD) with vitreous hemorrhage. No predisposing anatomic risk factors were present except for the vitreous loss. During the RD repair, 2 small superior tears were discovered. Eleven months later, the patient had uneventful phacoemulsification in the fellow eye. On postoperative day 1, he again had a total RD with a superior retinal tear. Meticulous retinal evaluation had been performed preoperatively, and no holes or tears were discovered. The RD was repaired, and the best corrected visual acuity at the last examination was 20/40 in both eyes.

Retinal detachment following intracapsular cataract extraction

A retrospective investigation of aphakic retinal detachments following intracapsular cataract extraction during a 12-year period was performed. A total of 8350 eyes had intracapsular cataract extraction in the study period and 118 eyes developed aphakic retinal detachment. The occurrence of retinal detachment is related to age, sex, intraoperative complications, myopia, hyperopia, and pseudophakia. Age and myopia were significantly associated with aphakic retinal detachment. Previous aphakic retinal detachment in the one eye was a strong predictor for the other eye.

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. III. Surgical results

Surgical results and complications were studied retrospectively in 590 cases of retinal detachment in a population-based material of 538 patients. Of the 590 cases 96.3% were operated upon, and 22.9% of these underwent one or more re-operations. The technique used was cryo- or photocoagulation (100%) + scleral buckling or an encircling band (96%) + drainage of subretinal fluid (80%). The surgical complications were intraocular bleeding (13%), choroidal detachment (7%), and proliferative vitreo-retinopathy (5%). All complications were significantly more frequent after re-operations. Complete re-attachment was achieved in 78.1%. The re-attachment rate was significantly lower in aphakic cases (66.7%) than in phakic non-traumatic cases (80.8%). The visual acuity in re-attached cases was better than 0.5 in 33.7% and better than 0.1 in 72.2%.

Epidemiology of aphakic retinal detachment following intracapsular cataract extraction: a follow-up study with an analysis of risk factors

We reviewed 604 eyes in 521 patients who had intracapsular cataract extraction. The follow-up period averaged 39 months. The incidence of rhegmatogenous aphakic retinal detachment (ARD) was 1.3% in the whole group. The ARD incidence was 1.0% in eyes without surgical complications and 5.4% in myopic eyes (myopia defined as an aphakic refraction less than or equal to +9.0 diopters). The log-rank test was used to estimate the statistical significance of various ARD predictors. Significant predictors were age at surgery below 70 years (P = .0004) and myopia (P = .001). Our results indicate that the high risk of ARD is concentrated in a small group of myopic patients operated on at a relatively early age. During the follow-up period, 128 patients died. Compared with the mortality rate of the entire Danish population, this was not an above average mortality rate. Thus, our results do not support the hypothesis that senile cataracts reflect general systemic deterioration rather than local eye disease.

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology

A population-based series of retinal detachments (RD) collected during a 10-year period (538 patients, 590 'cases', i.e. diseased eyes including new RD after 6 months in the same eye) is reported. The annual incidence was 10.6 per 100,000 population. Bilaterality was observed in 11.2%. In this material preponderance of the right eye was found. In non-traumatic RD there was a small sex difference, with a higher incidence among females. Older persons were at high risk of sustaining RD, as were myopes. In myopic males the risk increased with the degree of myopia and with increasing age. In myopic females the greatest risk was found in the age group 30-59 years. Myopic eyes are probably also more vulnerable to traumatic RD. Lattice degeneration was more common in middle-aged than in older patients and was also more common in myopic eyes than in eyes with other phakic RD. High myopia (greater than -5D) was more frequent in patients with lattice degeneration than in those without. Aphakia was found to be an important predisposing factor for RD. A classification taking into account the above-mentioned factors is proposed.

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. II. Pre-operative findings

In a population-based material of patients with retinal detachment (RD), the pre-operative findings in different subgroups were studied. In traumatic cases flap tears and round holes were found in at least as high a frequency as oral dialysis, or even higher. In aphakic cases subtotal or total RD was often observed on admission for surgery. A high proportion of aphakic eyes without lattice degeneration exhibited no breaks. RD in myopic eyes was usually large, and round holes were frequently found. Full-thickness fixed retinal folds were more seldom seen pre-operatively en myopic than in non-myopic eyes. Lattice degeneration was usually observed in myopic RD patients of ages less than 30 years, but mainly in hyperopic or emmetropic eyes in patients over 60. In RD with lattice, multiple breaks were frequently found. A comparatively large group of RD cases without lattice were non-traumatic, phakic and non-myopic (40%). Most of these patients were 60 years and older. Flap tears were often seen, and the detachment was seldom large in this group.

Prophylactic argon laser photocoagulation in retinal detachment fellow eyes

Over a two-year period (1975-76) 329 patients were operated for rhegmatogenous retinal detachment. 301 patients had unilateral detachment and in 62 of these prophylactic photocoagulation with argon laser in the fellow eye was performed. During the observation time one of these (1.6%) and 7 untreated (2.9%) fellow eyes developed retinal detachment. The indication for prophylactic photocoagulation of fellow eyes and the results are discussed.