Retinal detachment after cataract extraction in myopic eyes

Effect of Nd: YAG laser capsulotomy on the risk of retinal detachment after cataract surgery: A systematic review and meta-analysis

ABSTRACT

We aimed to evaluate the impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy on the incidence of pseudophakic retinal detachment (RD). The PubMed and Embase databases were searched for meta-analysis. Subgroup analyses were conducted according to study location, number of cases, mean follow-up time, and cataract procedure. The final analysis included 11 studies with 309 cases of RD in 65,117 eyes undergoing cataract surgery. Among them, 8,232 eyes underwent Nd:YAG capsulotomy. Our analysis demonstrated an increased risk of RD with Nd:YAG laser capsulotomy (RR=1.57; 95%CI, 1.17-2.12; P=0.003; HR=1.64; 95%CI, 1.03-2.62; P=0.04). Subgroup analysis suggested somewhat stronger associations in Asian (RR=4.54; 95%CI, 2.20-9.38; P<0.0001) than in non-Asian populations (America, P=0.12; Europe and others, P=0.21), and with extracapsular cataract extraction (RR=2.97; 95%CI, 1.83-4.83; P<0.0001) than with phacoemulsification (P=0.95). To conclude, Nd:YAG laser capsulotomy may be associated with an increased risk of pseudophakic RD.

Analysis of factors correlated with the development of pseudophakic retinal detachment--a long-term study in a single medical center

BACKGROUND

To analyze the possible factors correlated with the development of retinal detachment (RD) after cataract extraction and intraocular lens (IOL) implantation in a single medical center.

METHODS

We performed a retrospective chart review of patients receiving cataract extraction and posterior chamber IOL implantation from January 2000 to June 2010 at one medical center. We analyzed demographic characteristics, medical history, axial length (AL), operation method, intraoperative and postoperative complications, Nd-YAG posterior capsulotomy and records for RD.

RESULTS

The 9,184 patients analyzed included 6,464 males and 2,720 females, mean age 71.8 ± 9.1 years. The cumulative 7-year RD rate was 0.84 %. Young age, long axial length and intraoperative complications were significantly associated with the risk of pseudophakic RD. Although not a statistically significant factor for the whole group, Nd-YAG posterior capsulotomy represented a significant risk in those with high myopia stratified by axial length. In moderate myopic group, both intra-operative complication and Nd-YAG posterior capsulotomy showed more tendencies to increase risk of RD, but only intra-operative complication had significant difference.

CONCLUSIONS

Young age, myopia and intra-operative complications were significant risk factors for the development of RD after cataract extraction and IOL implantation. Post-operative Nd-YAG posterior capsulotomy led to more risk for pseudophakic RD in myopic eyes, especially high myopia. The risk of pseudophakic RD should be considered before deciding to perform cataract extraction and the following capsulotomy in myopic eyes, particularly those for refractive indication in young 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.

Male Sex as a Risk Factor for Pseudophakic Retinal Detachment after Cataract Extraction in Taiwanese Adults

PURPOSE

To investigate the role of sex in modifying risk factors for retinal detachment (RD) after cataract surgery.

DESIGN

Prospective cohort study based on medical records and insurance claims from Taiwan's Bureau of National Health Insurance (BNHI).

PARTICIPANTS

Nine thousand three hundred eighty-eight patients who underwent extracapsular cataract extraction (CE), including phacoemulsification procedures, between August 1999 and December 2001.

METHODS

Medical charts and claims submitted by insurance beneficiaries who underwent CE and intraocular lens implantation were collected from the sixth branch of the BNHI. Data recorded for analysis included each patient's demographic characteristics, medical history, refractive status, axial length (AL), type of CE, and intraoperative complications. Posterior capsulotomy, diagnostic procedures, and treatments for retinal complications and other ocular diseases were identified on the basis of codes from physicians' billing records at the end of 2005.

MAIN OUTCOME MEASURES

Incidence of RD in the full study group and in subgroups defined by sex, age, AL, type of CE procedure, concurrent systemic diseases, presence of intraoperative complications, and subsequent posterior capsulotomy.

RESULTS

The mean follow-up time of patients at the time of analysis was 54.99+/-15.53 months. The rate of lost follow-up was 11.55%. Cumulative 6-year RD rates were 1.16% in the full study group, 1.90% in the male subgroup, and 0.56% in the female subgroup at the end of the follow-up period. Gender distribution had a significant influence on the occurrence of RD after CE (P<0.001). Factors that were found to have a significant effect on the risk of pseudophakic RD included age under 50 years (P = 0.002), AL (P<0.001), and history of RD (P = 0.003). Surgical types (extracapsular vs. phacoemulsification) were not correlated significantly with RD, and neither were such systemic diseases as diabetes and hypertension. Subgroup analysis indicated that the significance of age, AL, and history of RD as risk factors persisted in the male subgroup but not in the female subgroup.

CONCLUSIONS

The impact of axial myopia, age, and RD history as risk factors for pseudophakic RD was seen predominantly in males.

AXIAL MYOPIA IS AN EXTREMELY SIGNIFICANT RISK FACTOR FOR YOUNG-AGED PSEUDOPHAKIC RETINAL DETACHMENT IN TAIWAN

PURPOSE

To investigate the possible risk factors of retinal detachment (RD) after cataract extraction and intraocular lens implantation in a geographic defined racially uniform population.

METHODS

Submitted claim records and charts of 9398 insurance beneficiaries who underwent cataract extraction and intraocular lens implantation between August 1999 and December 2001 were consecutively collected from the Bureau of National Health Insurance (BNHI). At the end of 2003, any ophthalmologic diagnosis and related treatment based on procedure and diagnosis codes listed in physician bills were evaluated.

RESULTS

The cumulative risk of RD in our study group was 0.76% at the end of follow-up. The mean follow-up time was 36.92 +/- 8.89 months. Sex distribution had no significant effect on the occurrence of RD after cataract extraction, whereas age distribution showed significant influence on the risk of RD after cataract surgery (P = 0.0307), as did the history of RD (P < 0.0001) and Nd-YAG laser posterior capsulotomy (P = 0.0001). Axial length also had a significant effect on the risk of RD after cataract extraction (P < 0.0001). The longer the axial length, the more impact on the risk of RD carried by young age.

CONCLUSIONS

The results showed that axial myopia is an extremely significant risk factor for young-aged pseudophakic RD in Taiwan.

Risk factors for retinal detachment after cataract surgery in southern Taiwan

BACKGROUND

This study was designed to investigate potential risk factors for retinal detachment (RD) after cataract surgery in southern Taiwan.

METHODS

This was a prospective cohort study. Submitted charts and claimed records for insurance beneficiaries who underwent cataract extraction between August 1999 and December 2001 were collected from the Bureau of National Health Insurance. Data from these records were examined, including demographic characteristics, past history, refractive status, axial length, and type and complications of cataract extraction. At the end of 2002, any ophthalmologic diagnosis and related treatments, based on procedure and diagnosis codes listed in physician bills, were evaluated.

RESULTS

A total of 9,398 patients were evaluated. The cumulative risk of RD in our study group was 0.4% at the end of follow-up. The mean follow-up time was 25.5 +/- 7.7 months. Age had a significant influence on the risk of RD after cataract surgery (p = 0.006), whereas gender did not. Axial length also had a significant effect on the risk of RD after cataract extraction (p < 0.001), whereas systemic disease or the type of operation did not correlate significantly with RD. Intraoperative complications had a significant influence on RD risk only in patients aged more than 60 years (p = 0.042). Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy significantly reduced the risk of RD only in patients aged 50 years or younger (p < 0.001).

CONCLUSION

Our results show that young age and long axial length are both significantly associated with RD after cataract surgery. A more restrictive attitude towards early cataract extraction may therefore be appropriate, especially in highly myopic patients.

Refractive lens exchange for myopia: a new perspective?

PURPOSE OF REVIEW

Although lens surgery for high myopia has a long History, it has been extremely controversial. Colin's study of 1999 indicated a much higher than expected rate of retinal detachment. The purpose of this review is to reassess the place of refractive lens exchange in high myopia in the light of more recent reports in the literature and a more critical examination of Colin's data.

RECENT FINDINGS

A meta analysis of papers on refractive lens exchange and cataract in high myopia between 1996 and 2004 included some 2036 eyes. The mean follow up was 43.5 months and overall incidence of retinal detachment was 1.85%. This is only slightly different from that expected in the highly myopic population as reported by Burton at 1.5%. The recent reports in 2003 of Ravalico et al. and Guell et al., with 4 year follow up, show only 1 detachment for 422 eyes. Further Colin's study had a group very high in risk factors having a low incidence of posterior detachment and 30% pre-existing retinal lesions.

SUMMARY

Modern surgical techniques, IOLs and choosing the appropriate group to whom this procedure should be offered should lead to it becoming an accepted, safe and common refractive operation.

Small incision clear lens extraction for correction of high myopia

PURPOSE

To evaluate the effectiveness, predictability, and safety of clear lens extraction in the correction of high myopia.

SETTING

Kartal Education and Research Hospital, Istanbul, Turkey.

METHODS

This retrospective study comprised 56 eyes of 30 patients who had clear lens extraction to correct myopia of 12.00 diopters (D) or more. Small incision clear lens extraction using an anterior chamber maintainer was performed and low-power posterior chamber intraocular lens (IOL) was implanted. The mean postoperative follow-up was 40.2 +/- 11.9 months.

RESULTS

Uncorrected visual acuity improved in 94.6% of eyes. Best-corrected visual acuity (BCVA) improved in 37 eyes (66%); 27 (48.2%) gained two or more lines. The percentage of eyes achieving a BCVA of 20/40 or better increased from 26.7% preoperatively to 58.9% postoperatively. Of the eyes, 38 (67.8%) were within +/- 1.00 D of targeted refractive error and 52 (92.8%) were within +/- 2.00 D. Posterior capsule tear with vitreous loss occurred in one eye (1.7%). During the follow-up, retinal detachment (RD) occurred in 2 eyes (3.5%).

CONCLUSIONS

Clear lens extraction and IOL implantation was effective and had an acceptable predictability and a low morbidity in correcting high myopia. Regular retinal examination is necessary to prevent postoperative RD.

Cataract surgery as a risk factor for retinal detachment in very highly myopic eyes

PURPOSE

To evaluate the incidence of retinal detachment (RD) after cataract surgery performed by phacoemulsification in very highly myopic eyes.

DESIGN

Retrospective, paired-eye, case-control trial.

PARTICIPANTS AND INTERVENTION

We assessed the development of RD in 930 eyes from 930 subjects (mean age = 62.5 +/- 8.5 years) affected by very high myopia (between -15 and -30 diopters) undergoing cataract surgery after uncomplicated phacoemulsification (cataract-subjected [CS] eyes). Fellow eyes served as controls. Follow-up was 36 months.

MAIN OUTCOME MEASURE

Detachment of the retina.

RESULTS

Retinal detachment was observed in 8.0% of CS eyes compared with 1.2% of control eyes (P<0.01, chi-square test). In CS eyes, posterior RD was most common (52.7% of eyes with RD). In control eyes, peripheral detachments with or without macular involvement were most common (47.3% of eyes with RD).

CONCLUSION

Cataract surgery, despite the use of a safe technique such as phacoemulsification, increases the risk of RD development in very highly myopic eyes.

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.

Retinal detachment after phacoemulsification cataract extraction

PURPOSE

To estimate the incidence of retinal detachment (RD) after phacoemulsification cataract extraction in an unselected group of patients.

SETTING

Herlev University Hospital, Copenhagen, Denmark.

METHODS

This retrospective review comprised 6521 cataract patients who had phacoemulsification over a 3-year period. The incidence of postoperative RD and the risk factors were assessed.

RESULTS

During the 15- to 52-month observation period, 22 cases of RD in 21 patients were observed, with an estimated risk (Kaplan-Meier) of 0.41% (95% confidence limit, 0.25%-0.57%) at 52 months. The results confirmed recognized preoperative risk factors for RD such as an axial length greater than 25.0 mm (P<.001), age younger than 65 years (P<.001), and male sex (P<.02). In 18 eyes, the retina was reattached after 1 operation.

CONCLUSIONS

The incidence of RD after phacoemulsification cataract extraction in an unselected group of patients was low. A long axial length, young age, and male sex were confirmed as risk factors.

Retinal detachment after cataract extraction and refractive lens exchange in highly myopic patients

PURPOSE

To assess the refractive effects and incidence of postoperative complications in patients with high myopia after cataract extraction.

SETTING

University Eye Clinic, Trieste, Italy.

METHODS

This noncomparative retrospective study comprised all eyes (N = 388) having cataract extraction and implantation of an intraocular lens with a power less than 11.0 diopters (D) between 1986 and 1999. The preoperative and postoperative refractions; preoperative, postoperative, and final best corrected visual acuity (BCVA); and postoperative complications were analyzed. The mean follow-up was 47.16 months +/- 32.83 (SD) (range 8 to 146 months).

RESULTS

Phacoemulsification was performed in 237 eyes, extracapsular cataract extraction in 147 eyes, and intracapsular cataract extraction in 4 eyes. The mean preoperative BCVA was 0.20 +/- 0.21 and the mean postoperative BCVA, 0.58 +/- 0.32. At the final evaluation, the mean BCVA was 0.50 +/- 0.33. The mean refraction was -15.95 +/- 5.86 D preoperatively and -2.00 +/- 1.62 D postoperatively. One eye (0.26%) developed a retinal detachment postoperatively. Of the 127 eyes (32.73%) having a neodymium:YAG laser capsulotomy for posterior capsule opacification, 1 had a macular retinal hole. Posterior detachment of the vitreous occurred in 78.6% of cases. Peripheral retinal photocoagulation was required in 8 cases postoperatively.

CONCLUSION

Refractive lens exchange led to good functional results and a low incidence of postoperative complications and can thus be regarded as a viable technique to correct high myopia associated with cataract. However, further study is required before it can be routinely recommended for the correction of high myopia in eyes with a transparent crystalline lens.

Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: four-year follow-up

PURPOSE

To assess the safety of lens extraction and intraocular lens (IOL) implantation in patients with high myopia treated for initial lens opacity and/or refractive indications.

SETTING

Instituto de Microcirugía Ocular de Barcelona, Barcelona, Spain.

METHODS

This retrospective nonrandomized case series study comprised 44 eyes of 30 consecutive myopic patients who had surgery because of initial lens opacity and/or refractive indications during a 2-year period. In each case, phacoemulsification was performed using an ultrasonic technique and an IOL was implanted in the capsular bag. The patients were seen preoperatively to evaluate retinal pathology. They also had a complete ophthalmologic evaluation that included detailed indirect ophthalmoscopy. All patients were followed at regular intervals. The main outcome measures were preoperative and postoperative spherical equivalent (SE), the incidence of posterior capsule opacification (PCO) and the need for capsulotomy, and the incidence of retinal complications.

RESULTS

In all eyes, the surgery was uneventful. The mean patient age at surgery was 42.83 years; the mean preoperative SE was -15.77 diopters (D) and the mean postoperative SE, -1.05 D. No eye required preoperative peripheral retinal photocoagulation. Twenty-five eyes (56.8%) had PCO and had a neodymium:YAG laser capsulotomy. One eye had a retinal tear 14 months after surgery and was treated with focal photocoagulation. The mean endothelial cell loss was 2.1% during the first postoperative year. Two eyes had an immediate postoperative intraocular pressure (IOP) rise, 1 with an inflammatory membrane and the other with corneal edema; both resolved with topical treatment. One eye with elevated IOP and a bad response to medical treatment had argon laser trabeculoplasty. No eye had a retinal detachment during the follow-up.

CONCLUSION

With a thorough preoperative ophthalmologic evaluation and uneventful surgery, patients who have phacoemulsification and IOL implantation for the correction of myopia have a satisfactory chance of obtaining good visual results with few complications.

Cataract surgery by phacoemulsification in adults with retinopathy of prematurity

PURPOSE

To report the preoperative, operative, and postoperative factors associated with phacoemulsification cataract surgery in adults with retinopathy of prematurity.

METHODS

Records of patients with retinopathy of prematurity who underwent phacoemulsification at The Wilmer Institute between January 1990 and January 2000 were retrospectively searched. Seventeen adults (9 women, 8 men) with retinopathy of prematurity were identified who had undergone phacoemulsification for visually significant cataract or phacomorphic glaucoma and who had at least 6 months of postoperative follow-up.

RESULTS

Cataract extraction by phacoemulsification was performed on 20 eyes. Follow-up ranged from 6 to 103 months (mean, 32 months). A posterior chamber intraocular lens was placed in 18 eyes; two eyes were left aphakic for refractive reasons. Zonular weakness was noted in two eyes in which the intraocular lens was suture fixated to the sclera. Concomitant trabeculectomy was performed in one eye. Visual acuity improved in 18 of 20 eyes and remained unchanged in two eyes. Postoperatively, visual acuity was worse than 5/200 in two eyes, 5/200 to worse than 20/100 in five eyes, 20/100 to 20/50 in five eyes, and 20/40 or better in eight eyes. One eye developed a rhegmatogenous retinal detachment 1 month after cataract surgery; the retina was successfully reattached.

CONCLUSIONS

Although cataract extraction in eyes with regressed retinopathy of prematurity may present challenges, such as high myopia, monocularity, glaucoma, and previous ocular surgery, phacoemulsification in this series proved to be relatively safe as well as visually rehabilitating. The surgeon should be aware of the special considerations in this population, alert to potential zonular weakness intraoperatively, and careful of increased postoperative risks, including retinal detachment.