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Accommodating IOL may be associated with higher rate of postop retinal detachment
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 Michael M. Lai |
BOSTON — Retinal detachment may be more common among patients implanted with an accommodating presbyopia-correcting IOL, a study found.
The retrospective cohort study, presented here at the American Society of Retina Specialists meeting, included 315 cataract surgery patients implanted with a multifocal ReSTOR IOL (Alcon) and 214 implanted with an accommodating Crystalens (Bausch + Lomb).
"The results of our study suggest that Crystalens may be associated with increased incidence of retinal detachment. Therefore, we recommend caution in the use of this lens, particularly in patients with risk factors for retinal detachment," Michael M. Lai, MD, PhD, said.
Of eyes that received the ReSTOR, 0.6% developed retinal detachment, compared with 3.7% of those implanted with the Crystalens (P = .0179). According to the study authors, the ReSTOR rate correlated with those previously demonstrated for monofocal IOLs; however, the Crystalens rate was notably higher.
Dr. Lai speculated that increased risk for retinal detachment may be due to IOL design. Accommodating lenses feature a larger overall dimension and hinges that allow for more movement; increased size places the haptics in close contact with the peripheral vitreous base, and extra movement may boost traction, Dr. Lai said.
- Disclosure: Dr. Lai has no relevant financial disclosures.
This is an interesting and thought-provoking study. However, it is a relatively small study and has the all the unintended biases of a retrospective chart review. For instance, surgical skill and complications may have biased the results, particularly if the surgeons placed the IOL they preferred. More YAG laser, which is a known (and not controlled) risk factor for retinal detachment, was performed on the Crystalens group. The physiologic explantation of a larger IOL with more movement and more potential traction on the peripheral vitreous base is an attractive hypothesis. Yet, we must be cautious and not jump to conclusions for the reasons mentioned above. This is an important study with significant potential implications, but its outcomes require further confirmation from a large, well-designed, prospective study.
– Pravin U. Dugel, MD
Managing partner,
Retinal Consultants of Arizona, Clinical associate professor, Department of
Ophthalmology, Doheny Eye Institute
Disclosure:Dr. Dugel is a consultant
to Alcon Surgical.