Aphakic retinal detachment

A 21-Year Study of Vitreoretinal Surgery for Aphakic Retinal Detachment: Long-Term Surgical Outcomes and Complications

PURPOSE

To determine the characteristics and outcomes of primary retinal detachment (RD) surgery in aphakic patients.

DESIGN

Retrospective case series.

PARTICIPANTS

Sixty eyes with primary aphakic RD (ARD) in 51 patients.

METHODS

A consecutive series of patients who underwent vitreoretinal surgery for primary rhegmatogenous ARD was analyzed retrospectively between 1997 and 2018 at Moorfields Eye Hospital.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA), surgical outcomes, and complications.

RESULTS

Mean BCVA improved from 1.31 to 1.08 logarithm of the minimum angle of resolution (logMAR; P = 0.081) over a mean follow-up period of 8.2 years. Macula-off retinal detachments showed significantly improved BCVA from 1.72 to 1.1 logMAR (P = 0.007). Mean age was 38.8 years, and the most common cause of aphakia was congenital cataract surgery (55%). The macula was attached in 45% eyes, and grade C proliferative vitreoretinopathy (PVR) was present in 12%. Operations performed were vitrectomy (88%), combined vitrectomy and scleral buckle (8%), and encirclement (3%). The final anatomic success rate was 88%, and PVR was a significant predictor of redetachment (P = 0.03; odds ratio, 20.7; 95% confidence interval, 2.8-152.2). Raised intraocular pressure was the most common postoperative complication at 30%, with a rate of de novo postoperative glaucoma of 6.7% at final follow-up.

CONCLUSIONS

We report high rates of primary and overall anatomic success for surgery in ARD surgery. Grade C PVR was a positive predictor for surgical failure. Final visual outcomes were limited by ocular comorbidity, and we report significant improved visual outcomes for macula-off ARD.

Pseudophakic rhegmatogenous retinal detachment in a large Asian tertiary eye centre: a cohort study

BACKGROUND

To determine the incidence and identify risk factors for the development of rhegmatogenous retinal detachment in patients who had cataract surgery at the Singapore National Eye Centre between 2001 and 2003.

DESIGN

Retrospective case-control study.

PARTICIPANTS

All patients who had cataract surgery between 2001 and 2003 and subsequently retinal detachment surgery in the same eye, between 2001 and June 2008, at Singapore National Eye Centre.

METHODS

Review of case records.

MAIN OUTCOME MEASURES

Incidence of posterior capsular rupture and retinal detachment.

RESULTS

Thirty-nine eyes, out of 24 846 cataract operations performed between 2001 and 2003, developed rhegmatogenous retinal detachment in the follow-up period from 2001 to 2008 (cumulative incidence 0.16%, 95% confidence interval 0.11-0.21%). Of the 508 eyes with posterior capsular rupture during cataract surgery, nine developed retinal detachment (cumulative incidence 1.77%, 95% confidence interval 0.87-3.23%). Men were more likely to develop retinal detachment (P < 0.001). On Kaplan-Meier survival analysis, younger patients had a higher probability of retinal detachment in comparison with older subjects (P < 0.001). Similarly, eyes with posterior capsular rupture during surgery had shorter interval duration to retinal detachment, compared with eyes that did not (P = 0.002). When compared with patients more than 70 years of age, younger patients had significantly higher hazard ratios of retinal detachment (hazard ratio 19.7, 95% confidence interval 3.6-107.3, P < 0.05).

CONCLUSION

The incidence of pseudophakic retinal detachment in our institution is low. Posterior capsular rupture during surgery, men and younger age at time of surgery increases the risk of developing retinal detachment, and careful observation for the occurrence of retinal detachment may be warranted in these groups of patients.

Pseudophakic retinal detachment after phacoemulsification

The authors estimated the onset, incidence and treatment of pseudophakic retinal detachment after phacoemulsification and intraocular lens implantation in 11,098 consecutive patients over a 10-year period. About 40 eyes in 37 patients were diagnosed with pseudophakic retinal detachment (risk = 0.36%). Significant risk factors included: axial length > 25.0 mm, age < 65 years and intraoperative complications. The final best corrected visual acuity improved by 2 or more Snellen E lines in 52.5% of cases.

Risk factors for retinal detachment after cataract surgery: a case-control study

PURPOSE

To determine risk factors for rhegmatogenous retinal detachment after cataract surgery.

DESIGN

Retrospective case-control study.

PARTICIPANTS AND CONTROLS

A consecutive series of 63298 cataract surgery procedures in 45520 patients performed between August 1994 and March 2003 was identified. After exclusions for incomplete data, 249 cases of pseudophakic retinal detachment were matched with 845 controls that had cataract surgery on the same day, but without subsequent retinal detachment.

METHODS

Details were extracted from the clinical records. A conditional logistic regression model for matched case-control groups was used. Multiple regression analysis was performed to estimate the odds ratio for each variable, with adjustment for the effects of other variables selected from the candidate pool.

MAIN OUTCOME MEASURES

Occurrence of rhegmatogenous retinal detachment.

RESULTS

The major risk factors (odds ratio [OR], 95% confidence interval [CI], P value) for detachment were posterior capsule tear (OR, 19.9; CI, 10.8-36.7; P<0.001), zonule dehiscence (OR, 12.4; CI, 3.8-41.2; P<0.001), retinal detachment in fellow eye (OR, 12.3; CI, 5.2-29.1; P<0.001), axial length >23 mm (OR, 3.2; CI, 2.0-5.0; P<0.001), and male gender (OR, 2.2; CI, 1.4-3.3; P<0.001). For patients aged >64 years, the odds ratio was linearly reduced for each subsequent decade. Differences in the surgical technique (i.e., phacoemulsification vs. extracapsular extraction), type of anesthetic, prior glaucoma, or subsequent neodymium:yttrium-aluminum-garnet laser posterior capsulotomy were not significantly related to retinal detachment. Approximately 37% (CI, 35%-38%) of retinal detachment was attributable to posterior capsule tear.

CONCLUSIONS

Patient characteristics rather than surgical complications constitute the major risks factors for retinal detachment after cataract surgery.

Northern New Zealand Rhegmatogenous Retinal Detachment Study: epidemiology and risk factors

BACKGROUND

The incidence of retinal detachment in New Zealand is not currently documented in the literature. This study sought to determine the annual incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors in northern New Zealand.

METHODS

Epidemiological and clinical data were collected for all patients presenting with a RRD in a 12-month interval in a confined geographical area of New Zealand.

RESULTS

One hundred and forty-one patients presented between May 1997 and April 1998 with a RRD. Five patients presented with bilateral RRD. The mean age at presentation was 53.9 years and the annual incidence for RRD was 11.8 cases per 100,000 people. RRD was more common in males than in females (1.3:1). Ocular trauma, high myopia and cataract extraction were found to be significant risk factors in the development of RRD.

CONCLUSIONS

The annual incidence of RRD in northern New Zealand is comparable to values reported for other parts of the world and, consistent with previous studies, the incidence of RRD was found to increase with age, and in association with trauma, high myopia and cataract surgery.

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.

Pseudophakic retinal detachment

A total of 93 cases of pseudophakic retinal detachment are reported. The present study showed that vitreous loss had occurred during cataract surgery in 28% of eyes, indicating that anterior segment complications are an important contributory factor to aphakic retinal detachment in these cases. There was impairment of the retinal view in 46% of eyes, and in 22.5% no retinal breaks could be identified. The main factor responsible for poor visibility was inadequate pupillary dilatation, which was found particularly in association with the use of iris-supported lenses. Detachment of the macula was unexpectedly found to occur in as many as 88% of cases. Reattachment of the retina either by conventional detachment procedures or by pars plana vitrectomy was achieved in 76.3% of eyes. Complications directly attributable to the presence of an intraocular lens (such as dislocation or haemorrhage) are described. Failure of surgery was more likely to occur in eyes exhibiting a poor fundal view, in which the detection of retinal breaks was difficult. The best results were achieved in eyes in which posterior-chamber lenses had been implanted.

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 following YAG laser capsulotomy

A retrospective study of 12 patients with rhegmatogenous retinal detachment following YAG posterior capsulotomy is reported. Eleven out of these 12 were at increased risk of detachment. Three had lattice degeneration, three had previous detachment and five had axial myopia. Only 50% of the holes were typical "aphakic" post-oral breaks.

Pseudophakic retinal detachments and post-operative visual acuity

We reviewed 254 cases of extracapsular cataract extraction and posterior chamber intraocular lenses (ECCE & IOL) which were performed between the years 1983 and 1985 at the Royal Victoria Hospital, Belfast. The aim of the study was to evaluate the incidence of pseudo-phakic retinal detachment in uncomplicated cases of ECCE & IOL. The incidence of retinal detachment (RD) was found to be 0.79% overall. The incidence of other post-operative complications such as posterior capsular thickening was 2.8% and of cystoid macular oedema 1.2%.

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%.

Surgery of aphakic retinal detachment

In a prospective study 84 patients with aphakic retinal detachment were treated either by local scleral buckling alone or combined with an encirclement. The rate of surgical reattachment of the retina was found to be similar with either technique over a minimum follow-up period of one year. Simplicity and a low incidence of serious complications of the local procedure merit its application as the initial method of repairing aphakic detachments.

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.

Pseudophakic and aphakic retinal detachment mimicking cystoid macular edema

Seventeen eyes of patients who were being followed by their ophthalmologists for aphakic (8 eyes) or pseudophakic (9 eyes) cystoid macular edema (CME) were examined on referral. All eyes showed retinal detachment (RD), and eight eyes had CME with RD. Most RDs were inferior and shallow. Proliferative vitreoretinopathy (PVR) was noted in 15 eyes (88.2%). There was history of vitreous loss during the last intraocular surgery in 88.2% eyes. Visual acuity ranged from 20/40 to hand movements. Fundus view was hazy in most eyes, and indirect ophthalmoscopy was most useful in detecting RD. Retinal reattachment with scleral buckling and/or vitrectomy was achieved in 16 eyes (94.1%). Postoperative visual recovery was jeopardized due to longstanding macular detachment of greater than 1 month in 11 eyes (64.7%). Eight eyes (47%) achieved 20/50 vision whereas 25% did not improve to better than 20/400. Factors leading to failure in making the correct diagnosis and their prevention are discussed.

Retinal detachment after extracapsular cataract extraction with posterior chamber intraocular lens

The authors reviewed 3065 consecutive cases of extracapsular cataract extraction with posterior chamber lens implant (ECCE-PC IOL) and found the incidence of retinal detachment to be 1.4% overall (44/3065) and 1.7% in a group of eyes followed for at least 1 year (40/2330). Retrospective analysis of the retinal detachment (RD) group (n = 44) showed the patients to be significantly younger than the overall group (n = 3065) (P less than 0.0001). Comparison with an age-matched group of 302 eyes without RD showed higher rates of RD in males (P = 0.0013) and in eyes with axial eye length (AEL) greater than 25 mm (P less than 0.0001). No significant correlation was found between RD and PC IOL manufacturer, phacoemulsification (PKE), or primary discission. Sixty-four percent of RDs occurred within 1 year of cataract operation. Only 10% occurred more than 2 years later. Visual results in eyes with ultimate anatomic success of RD repair (43 of 44 eyes, averaging 15 months follow-up) are substantially better than previously reported in series with other types of IOLs (96% greater than or equal to 20/40 if the macula was not involved, 75% greater than or equal to 20/40 if the macula was involved).