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Retinal detachment after phaco: a closer look
A study shows most phaco complications do not seem to affect the features of retinal detachment occurring afterward.
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PARIS — Posterior capsular rupture and vitreous loss during phacoemulsification have no significant effect on the features or final visual outcome of subsequent retinal detachments, according to a study here.
However, eyes that underwent pars plana vitrectomy (PPV) to remove posteriorly dislocated lens fragments had a shorter time interval between surgery and retinal detachment, according to Claire Monin, MD, and colleagues.
“Furthermore, proliferative vitreoretinopathy (PVR) remains by far the major factor in predicting anatomic or functional failure for retinal detachment occurring after phaco with posterior chamber IOL implantation,” said Dr. Monin, of the Centre Hospitalier National d’Ophthalmologie des Quinze-Vingts.
Design and methods
The study was an interventional consecutive case series of patients. They all had retinal detachment following phaco, and all were followed for 6 months or longer postoperatively. Dr. Monin and colleagues conducted a retrospective chart review of 114 eyes of 114 consecutive patients. All retinal detachments that occurred in aphakic or pseudophakic eyes were checked; only retinal detachments that occurred after phaco were included in the study.
The mean age of the cohort was 64 years; 66% of the patients included were men. Cases were almost evenly split between right and left eyes.
During the final examination, data were gathered on the patients’ best corrected visual acuity, anatomic status and postop complication in the treated eye.
Researchers divided the patients into three groups. Eyes with posterior capsular rupture complicating the phaco procedure (group 1, n = 41) were compared with eyes that had an intact posterior capsule at the time of detachment (group 2, n = 60) and with eyes that had an Nd:YAG laser capsulotomy after uncomplicated phaco (group 3, n = 13).
Results
“Vitreous loss associated with posterior capsular rupture during phaco occurred in 76% of the patients in group 1. These 31 eyes thus underwent an anterior vitrectomy at the time of cataract surgery. Posteriorly dislocated lens fragments had to be removed by PPV in seven of the 31 eyes,” the researchers found.
The eyes that underwent removal of posteriorly dislocated lens fragments by PPV during phaco showed a significantly shorter time interval between phaco and retinal detachment (3.89 vs. 15.7 months, P = .0044).
The researchers found no correlation between features of retinal detachment (once it occurred) or final visual outcome and intraoperative phaco complications such as posterior capsule rupture, vitreous loss and posteriorly dislocated lens fragments. The overall anatomic reattachment rate in this study was 94%, they reported.
“Only redetachment associated with the development of PVR was significantly correlated with ultimate anatomic failure (P = .0036),” the authors wrote.
Best-documented postop visual acuity was similar in all three groups. In group 1, 88% of patients had BCVA of 20/40 or better. This result was 93% in group 2 and 92% in group 3. Only two eyes had BCVA of 20/60 or less, they said.
Three variables were independently correlated with visual results: more extensive retinal detachment (P = .0001); redetachment associated with the development of PVR (P = .0029); and failure to identify retinal breaks (P = .0114).
“Posterior capsule rupture and vitreous loss during phacoemulsification do not seem to affect the features or the final visual outcome of retinal detachment occurring [following phaco],” the researchers concluded.
The exception to this, they wrote, is a shorter time interval between phaco and retinal detachment in eyes that underwent PPV to remove posteriorly located lens fragments.
PVR is the major factor in predicting failure for retinal detachment after phaco with PC IOL implantation, they emphasized.
Retinal detachment rates
Estimates of retinal detachment rates after phaco vary, the researchers said. Estimates range from 0.45% to 3.6%, with the largest study to date finding an overall incidence of 1.17%, increasing to 5% if cataract surgery was accompanied by an anterior vitrectomy.
“This study [that found an overall rate of 1.17%] analyzed the features of retinal detachment after it occurred; therefore, the incidence of retinal detachment following phaco was not considered,” the authors wrote. “However, the increased incidence of retinal detachment reported after posterior capsular rupture and vitreous loss is consistent with the large number of eyes that had a posterior capsular rupture complicating the phaco procedure (group 1) in our series (41 out of 114, 36%) compared with the relative infrequency of such events during phaco.”
The study was published in the American Journal of Ophthalmology.
For Your Information:Reference:
- Claire Monin, MD, can be reached at Centre Hospitalier National d’Ophthalmologie des Quinze-Vingts, 28 rue de Charenton, 75571 Paris, France Cedex 12; fax: (33) 140-021-599; e-mail: claire-monin@quinze-vingts.fr.
- Haddad WM, Monin C, et al. Retinal detachment after phacoemulsification: A study of 114 cases. Am J Ophthalmol. 2002;133:630-638.