Retinal detachment after cataract surgery

Abstract

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predictive factors of poor anatomical and functional results. Methods: The authors retrospectively reviewed the files of 99 consecutive cases of aphakic and pseudophakic retinal detachment operated on by the same surgeon between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Results: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 had a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 14% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsnlar extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PVR was present in 30% of the patients and 51% of detachments occurred more than 24 months as a mean after cataract surgery. The overall anatomic reattachment rate was 88% with no significant difference between the aphakic and the pseudophakic patients, either with an anterior chamber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02). Negative prognostic indicators for reattachment included poor preoperative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior chamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retinal detachment can now be reattached with either scleral or vitreo retinal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitrectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicone oil improves anatomical results but the functional results remain inferior.

Outcomes of pseudophakic retinal detachment

“…The visual impact of a PRD is usually greater than a PCT, and in the present study, only 58.8% of eyes achieved a visual acuity of ≥6/12 after a PRD, which is a similar value to the 40.5% and 47.0% reported in other series (Greven et al. 1992; Berrod et al. 1996).…”

“…A low rate of reattachment is associated with an extensive retinal detachment, a detached macula, proliferative vitreo‐retinopathy (PVR), vitreous haemorrhage and choroidal detachment (Yoshida et al. 1992; Girard & Karpouzas 1995; Berrod et al. 1996; Benson et al.…”

“…A good visual outcome is associated with a short duration of detachment, an attached macula, a good preoperative visual acuity and the absence of preoperative PVR or uveitis (Isernhagen & Wilkinson 1988, 1989; Girard & Karpouzas 1995; Bartz‐Schmidt et al. 1996; Berrod et al. 1996; Campo et al.…”

Capsule complication during cataract surgery: Retinal detachment after cataract surgery with capsule complication

“…It is well established that the visual prognosis after RD is dependent on the status of the macula before RD surgery. 14,[27][28][29][30] It is therefore important that all patients with a capsule complication during cataract surgery, which by itself leads to a substantial increase in the risk for RD, are informed of the early symptoms of RD. This information should also be given to cataract surgery candidates with other known risk factors for pseudophakic RD, such as myopia or young age.…”

Triamcinolone acetonide suspension toxicity to corneal endothelial cells

“…1,2 To help surgeons visualize prolapsed vitreous in the anterior chamber, Burk et al 3 introduced a synthetic glucocorticoid, triamcinolone acetonide (TA), prepared as a milky-looking suspension in its 10-fold dilution. A TA suspension can also aid in visualization of the vitreous and posterior hyaloid during pars plana vitrectomy.…”