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Laser prophylaxis linked with elevated retinal detachment risk after cataract surgery
J Cataract Refract Surg. 2008;34(10):1644-1657.
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More patients who had localized prophylactic argon laser treatment for retinal degeneration had detached retinas after cataract surgery than those who had no prior laser treatment.
However, researchers were unable to identify laser treatment as a risk factor for postoperative retinal degeneration.
Researchers performed a retrospective chart review that included 2,356 eyes of 1,519 patients who had undergone phacoemulsification and IOL implantation. Mean patient age at the time of surgery was 64.83 years. All eyes had minimum axial length of 27 mm. Median follow-up was 49 months.
Sixty-one eyes of 55 patients had a detached retina postoperatively; 30% occurred within 6 months, 43% during the first year and 70% during the first 2 years. The incidence of postop retinal degeneration was 1.5% to 2.2%.
Data showed no significant correlations between age, gender, axial length, previous history of retinal degeneration and IOL type.
“The relevant retinal degeneration risk lies within the myopic eye itself,” the study authors said. “Based on the results in our study, no clear increase in the ‘natural’ risk for [retinal degeneration] can be shown.”
The authors have added to the existing evidence that patients with high myopia are at an increased risk of retinal detachment after cataract surgery, and that increased risk of retinal detachment is present whether the surgery is done by phacoemulsification or by older techniques. The authors do not identify anything that clinicians can do to avoid a retinal detachment in a highly myopic patient other than warn the patient of that risk factor. This warning may then become part of the patient’s decision whether or not to have surgery. The authors’ statement in the abstract that history of laser capsulotomy and increasing axial length had no statistically significant effect on the rate of retinal detachment is invalid, since the text of the study readily acknowledges that the study had insufficient power to study those risk factors.
– Jonathan C. Javitt, MD, MPH
Johns Hopkins University, Baltimore