The incidence of retinal detachment after cataract surgery

Association between vitiligo and risk of retinal detachment: a population-based cohort study in Taiwan

BACKGROUND

Vitiligo is reportedly associated with several ocular abnormalities. However, the relationship between vitiligo and retinal detachment (RD) remains unclear.

OBJECTIVES

To examine the risk of RD in patients with vitiligo.

METHODS

A nationwide population-based cohort study was conducted using data from the Taiwan National Health Insurance Database from 2007 to 2018. A total of 21 132 patients with vitiligo were matched in a 1 : 4 ratio with people without vitiligo by age, sex and comorbidity propensity score. Cumulative incidence and Cox proportional hazard models were used to investigate the risk of RD in patients with vitiligo. Subgroup analysis was performed.

RESULTS

The cohort with vitiligo had a significantly higher rate of RD than the cohort without vitiligo [adjusted hazard ratio (aHR) 1.44, 95% confidence interval (CI) 1.20-1.72; P < 0.001]. Patients with vitiligo who required treatments such as phototherapy, systemic corticosteroids or immunosuppressants exhibited an even greater risk of RD (aHR 1.57, 95% CI 1.16-2.14; P = 0.004).

CONCLUSIONS

Our study revealed a 1.44-fold increased risk of RD in patients with vitiligo, with an even higher risk in patients receiving phototherapy, systemic corticosteroids or immunosuppressants. The risk remained consistently higher over a 10-year follow-up period.

Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study

PURPOSE

The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support.

METHODS

This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more.

RESULTS

Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively.

CONCLUSION

The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.

Five-year follow-up of a posterior chamber phakic intraocular lens with a central hole for correction of myopia

PURPOSE

To evaluate intermediate and long-term visual outcomes and safety of a phakic intraocular posterior chamber lens with a central hole (ICL V4c) for myopic eyes.

METHODS

Retrospective, consecutive case study of patients that uneventfully received a ICL V4c for myopia correction, with a 5-year postoperative follow-up. Department of Ophthalmology, Goethe University Frankfurt, Germany.

RESULTS

From 241 eyes that underwent ICL implantation, we included 45 eyes with a mean age at surgery of 33 years ± 6 (18-48 years), with a 5 years follow-up. CDVA improved from 0.05logMAR ± 0.15 CDVA preoperatively to  - 0.00 ± 0,07 at 5 years and did not change significantly from 3 to 5 years' time (p = 0.266). The mean spherical equivalent (SE) improved from -10.13D ± 3.39 to  - 0.45D ± 0.69. The change in endothelial cell count showed a mean decrease of 1.9% per year throughout the follow-up. Safety and efficacy index were 1.16 and 0.78, respectively. Cataract formation was seen in 2 of 241 eyes (0.8%), but in none of the 45 eyes that finished the 5-year follow-up.

CONCLUSIONS

Our data show a good intermediate and long-term stability, efficiency, and safety of ICL V4c phakic lenses in myopic eyes comparable to other known literature.

Visual Acuity Prior to Cataract Surgery and Risk of Retinal Detachment - A Population-Based Study

Purpose

To analyze preoperative visual acuity before cataract surgery regarding the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery.

Methods

The preoperative visual acuity in an observational cohort study of patients undergoing cataract surgery in Skåne, southern Sweden, during 2015-2017 was analyzed with data retrieved from the Swedish National Cataract Register. This was then cross-referenced with patients undergoing surgery for retinal detachment at the Skåne University Hospital in Lund from 2015 to 2020. The main outcome was the risk-benefit ratio of measuring preoperative visual acuity before cataract surgery and the risk of RRD.

Results

The mean visual acuity in the whole study group (N=58,624), expressed as LogMAR, was 0.40 ± 0.32 (SD). In the group with RRD (n=298), the mean visual acuity was 0.44 ± 0.36 (p=0.07). In the subgroups of RRD, those aged <60 years 0.49 ± 0.44 (p=0.07), aged <60 years and axial length (AL) >25 mm 0.42 ± 0.38 (p=0.68), and in those aged <60 years, AL >25 mm and male sex 0.44 ± 0.39 (p=0.53). However, there is considerable variations in visual acuity of the various groups and in the high-risk group with RRD aged <60 years with AL>25 mm, 15% had a visual acuity of 0.8 or better in the operated eye.

Conclusion

There must be strong indications for performing cataract surgery in those with a high risk of retinal detachment, and the patient must be given adequate information on the risk of retinal detachment.

Retinal detachment after cataract surgery: a population-based study

PURPOSE

To analyse the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery, and to identify possible risk factors.

METHOD

Observational cohort study of patients undergoing cataract surgery in Region Skåne, southern Sweden, during 2015-2017 were retrieved from the Swedish National Cataract Register. These were then cross-referenced with cases of retinal detachment surgery performed at the Skåne University Hospital in Lund from 2015 to 2020. The main outcome was RRD after cataract surgery. The influence of sex, age, axial length of the eye, rupture of the posterior capsule, patient comorbidity and other cataract complications were analysed.

RESULTS

Among the 58 624 cases of cataract surgery, a total of 298 RRDs (0.51%) were identified up to the end of 2020. The mean time from cataract surgery to RRD was 667 days. The mean age was 65.3 years, compared to 74 years in the control group. A strong correlation was found between RDD and age: <60 years, incidence = 0.50%; 60-75 years, incidence = 0.14%; and >75 years, incidence = 0.04%. The correlation with axial length was also very strong: mean value 23.73 mm in those without RRD, and 25.13 mm in those with RRD (p < 0.001). Sex was also strongly correlated to RDD; 68.8% of cases of RRD being men. Among men younger than 60 years of age, with an axial length ≥25 mm, 9.46% exhibited RRD within the follow-up period (mean 4.7 years). Rupture of the posterior capsule was found in 2.01% of RRD patients compared to 0.74% in the control group. Diabetes, glaucoma or pseudoexfoliation had no impact on the prevalence of RRD.

CONCLUSIONS

The three main risk factors for RRD following cataract surgery were found to be sex, age and axial length. The highest incidence of RRD (9.46%) were identified among men younger than 60 years of age and an axial length ≥25 mm.

Incidence of Rhegmatogenous Retinal Detachment (RRD) in a Tertiary Care Center of Pakistan

Background

Regardless of the advancements in ophthalmology, rhegmatogenous retinal detachment (RRD) remains a substantial issue for physicians. The present study assessed the incidence of RRD among our population.

Methodology

A cross-sectional study was performed at the Layton Rehmatullah Benevolent Trust (LRBT) between June 2020 and May 2021. All the patients of RRD, irrespective of gender, within the age bracket of 20 years or more and diagnosed by a consultant ophthalmologist were included in the research study. Patients with serous retinal or tractional detachment and RRD with vitreous leakage were excluded from the study. A slit lamp and dilated fundus examination was performed preoperatively to assess the type of retinal detachment and associated factors as mentioned above. All data were collected on predesigned pro forma.

Results

About 25,000 individuals were presented to the outpatient department during the study period. Out of these, 100 patients were diagnosed with RRD. The incidence rate of the RRD in our center was 0.4%. There were a majority of the males. The mean age of patients did not vary significantly with respect to gender (p < 0.797). The most common type of RD was the total RD with a frequency of 53 cases followed by inferior RD with 19 cases. The majority of those with total RRD were males, i.e., 37%; however, the difference was statistically insignificant (p = 0.476). The study revealed that most of the RRD was diagnosed in patients < 45 years of age; however, the difference was not statistically significant (p < 0.227).

Conclusion

The present study highlighted the incidence of RRD and explored the sociodemographic and other clinical features in the Pakistani population. However, it is possible that the RRD condition is still under-diagnosed in our hospital settings. Further exploration is warranted to study comprehensively the risk factors associated with RRD. 

Nd:YAG capsulotomy is not a risk factor for retinal detachment after phacoemulsification cataract surgery

PURPOSE

To evaluate the cumulative incidence and risk factors of pseudophakic retinal detachment (PRD) following phacoemulsification cataract surgery.

METHODS

Cataract surgeries performed between the years 2007 and 2016 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, were included. The cumulative incidence of PRD was estimated through Kaplan-Meier analysis. Patient mortality was incorporated as one of the censoring events. Cox regression analyses were used to evaluate potential risk factors, including age, gender, intraocular lens (IOL) power and previous neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy.

RESULTS

A total of 17 688 eyes of 12 003 patients were included. The mean patient age at surgery was 75.2 ± 9.1 years with 63.5% females (n = 11 228). During the mean follow-up time of 4.3 ± 2.7 years, 83 laterality-matched PRDs were registered (incidence 0.11% per year). Univariate analyses showed that age (HR 0.93; 95% CI 0.92-0.95), male gender (HR 3.99; 95% CI 2.52-6.33) and IOL power (HR 0.86; 95% CI 0.83-0.90) were significantly associated with PRD (p < 0.001 for all) and remained significant in a multivariate analysis. Neither univariate (HR 1.45; 95% CI 0.82-2.54, p = 0.201) nor multivariate (HR 1.03; 95%CI 0.57-1.88, p = 0.919) analyses showed any association between Nd:YAG capsulotomy and PRD.

CONCLUSIONS

Male gender, low IOL power and younger age were confirmed as risk factors for PRD after phacoemulsification surgery. Real-world evidence suggests that Nd:YAG capsulotomy does not increase the risk for PRD.

Effects of Neodymium-Doped Yttrium Aluminium Garnet (Nd:YAG) Laser Capsulotomy on Visual Outcomes From a Lower-Middle Income Country

Objective

Neodymium-doped yttrium aluminium garnet (Nd: YAG) laser is a non-invasive and effective means to deal with posterior capsule opacification. Although it is safe, it may have some complications. The purpose of this study was to evaluate the efficacy of Nd: YAG laser capsulotomy in terms of visual outcomes.

Methodology

This retrospective study was carried out at the eye department of Shaheed Mohtarma Benazir Bhutto Medical College, Lyari and Sindh Government Lyari General Hospital, Karachi, by using a convenient sampling technique. The duration of the study was six months from 1^st January 2020 to 30^th June 2020. 50 eyes of patients older than 20 years of age of either gender with posterior capsule opacification after cataract surgery for more than 6 months of duration, capsular fibrosis, and visual distortion due to wrinkling were included in the study. 

Results

Our results show that in a total of 50 patients, the mean age was 59.08±5.84 years, of which, 20 (40%) were males. Out of 50 patients, 22 right while 28 left eyes were selected for Nd: YAG laser capsulotomy. None of the patients showed elevated intraocular pressure (IOP) after the 1^st week. Mean IOP was 16.84±3.63 mm of Hg on the 1^st day and mean IOP after 1^st week was 12.48±2.01 mm of Hg. Iritis was observed in 5 (10.0%) patients on the 1^st day and 4 (8.0%) patients on the 1^st week. Raised IOP was observed in 10 (20.0%) cases whereas cystoid macular edema was observed in only 1 (2%) patients on the 1^st day and 1^st week after laser therapy.

Conclusion

The study predicted that Nd: Yag laser posterior capsulotomy gives excellent results in terms of visual acuity. Complications that were associated with the Nd: Yag laser capsulotomy was a rise in intraocular pressure, cystoid macular edema, iritis, and IOL pitting.

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.

Risk Factors for Retinal Detachment: A Case-Control Study

OBJECTIVE

The aim of this study was to investigate risk factors for retinal detachment or tear (RD/T), and follow up two studies that found increased risk from work-related heavy lifting.

METHODS

We conducted a case-control study including 200 cases of RD/T and 415 controls. Participants completed a questionnaire covering general health, vision, and physical exertion. Multiple logistic regression and propensity score matching was used to control confounding and estimate independent effects.

RESULTS

RD/T risk was increased by one lifting measure: current regular lifting of more than 30 lbs (>13.6 kg). In the population aged less than 65 years, the odds ratio comparing those with/without heavy lifting was 1.81, 95% confidence interval = 1.08 to 3.04.

CONCLUSION

Occupational heavy lifting may represent a risk factor for RD/T, but further research is needed in populations with frequent heavy physical exertion to more precisely quantify the risk.

Retinal detachment following cataract phacoemulsification-a review of the literature

A link between cataract surgery and rhegmatogenous retinal detachment (RRD) has long been considered. Indeed, pseudophakic retinal detachment (PPRD) forms a substantial and increasing proportion of RRD. We reviewed the literature to answer the following questions: what is the incidence of PPRD in eyes following phacoemulsification cataract surgery and how does its risk change over time following surgery? We also sought to assess how the risk is modified by intraoperative factors (operative complications, surgeon grade, subsequent laser capsulotomy), intrinsic eye-related factors (laterality, myopia, previous RRD, previous trauma, previous PVD) and patient factors (sex, age, ethnicity, affluence, systemic comorbidities). Secondarily we asked how the incidence of PPRD after phacoemulsification compares with the RRD incidence in the general population and how identified risk factors contribute to the pathophysiology of PPRD. A search of the Medline and Ovid databases was conducted for relevant publications from 1990 onwards using defined search terms with pre planned inclusion and exclusion criteria. The 10-year PPRD incidence after phacoemulsification was identified as being between 0.36 and 2.9%. This decreases over time to 0.1-0.2% annually but remains above the general population. The PPRD risk is further elevated by (in order of decreasing effect) intraoperative vitreous loss, increasing axial length, younger age, male sex and trainee operating surgeons. The PPRD risk after phacoemulsification is approximately ten times the general population's RRD risk. This risk is modified by the interplay of a hierarchy of risk factors, of which intraoperative vitreous loss, myopia, age and sex have the biggest effect.

Incidence of Intraocular Lens Exchange after Cataract Surgery

Intraocular lens (IOL) exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. The incidence of IOL exchange has not been consistently estimated. Such information is invaluable when counseling patients prior to cataract surgery. We examined the incidence of, and indications and risk factors for, IOL exchange after cataract surgery. We also assessed visual outcome of eyes that had an IOL exchange. A cohort design was used to estimate the incidence of IOL exchange and a case-control design to identify factors associated with it. All phacoemulsification surgeries with IOL (n = 17415 eyes) during 2010–2017 and those that had a subsequent IOL removal or replacement during the same time period were identified (n = 34 eyes). The incidence of IOL exchange was 2 per 1000 surgeries (95% confidence interval [CI] 1 to 3) over 8 years. Eyes that underwent subsequent IOL removal or replacement were compared with eyes that had cataract surgery only (n = 47) across demographic and clinical characteristics. In a binary logistic regression analysis, two factors were significantly associated with IOL exchange/removal: an adverse event during cataract surgery (adjusted odds ratio [aOR] 19.45; 95% CI 4.89–77.30, P < 0.001) and a pre-existing ocular comorbidity (aOR 10.70; 95% CI 1.69–67.63, P = 0.021). The effect of gender was marginally significant (P = 0.077). Eyes that underwent IOL exchange or explantation were nearly two and a half times more likely to have a final best-corrected visual acuity of <20/60 compared to those that had cataract surgery alone (adjusted RR 2.60 95% CI, 1.13–6.02; P = 0.025).

Long-term Clinical Results of Vitrectomy and Scleral Buckling in Treatment of Rhegmatogenous Retinal Detachment

Purpose

Most studies about retinal detachment cover a limited follow-up period. The purpose of this research is to assess the long-term results after pars plana vitrectomy (PPV) and scleral buckle (SB) surgery in patients with rhegmatogenous retinal detachment (RRD).

Methods

155 patients with RRD are treated either with SB or PPV with a mean follow-up of more than 5 years. Retrospective analysis of patient data with RRD was performed between January 2006 and June 2008 at a tertiary eye clinic.

Results

Overall primary success rate was 85.2% (PPV: 84.6%, SB: 89.5%; p=0.57). 90.5% of redetachments appeared within the first 124 days. No significant different success rate was found for vitrectomy with and without additional encircling band (p=0.09). No advantage of a supplemental encircling band in cases of preoperative inferior breaks was seen (p=0.81). Patients of SB group were treated more frequently in follow-up time because of epiretinal membrane (ERM) (SB: 15.5% versus PPV: 7.3%). No patient of the PPV group without intraoperative use of endolaser cerclage (14.7%) had any peeling surgery postoperatively.

Conclusion

Redetachment rates of both methods are comparable in a clinical setting where PPV is considered a suitable method for pseudophakic patients and in complex cases and SB was performed in younger phakic patients with clearly identified retinal tears. PPV seems to show a more heterogenous pattern of complications. No advantage of a supplemental encircling band could be found in these case series of patients with primary RRD. No relevant long-term risk of redetachment was seen after SB.

Peak Occurrence of Retinal Detachment following Cataract Surgery: A Systematic Review and Pooled Analysis with Internal Validation

Introduction

Timing of retinal detachment (RD) following cataract surgery is of importance for both diagnostic and prognostic factors. However, results on RD onset-time following cataract surgery have been conflicting.

Method

A systematic pooled analysis of the literature regarding timing of retinal detachment following cataract surgery. Outcomes were verified against an independent dataset.

Results

Twenty-one studies, reporting on rates of RD in 3,352,094 eyes of 2,458,561 patients, met our inclusion criteria and were included in the analysis. The mean pooled time to RD following surgery was 23.12 months (95% CI: 17.79-28.45 months) with high heterogeneity between studies (I ²=100%, P < 0.00001). Meta-analytic pooling for the risk of retinal detachment revealed a risk of 1.167% (95% CI: 0.900 to 1.468, I ²=99.50%, P < 0.0001). A retrospective chart review identified 54 pseudophakic RD cases (mean age 65.5, 59.3% males). The 95% confidence interval for the mean time to RD was 3.1-6.75 years.

Conclusions

The interval between cataract surgery and RD in a pooled analysis revealed a mean time of approximately 1.5-2.3 years. However, there was high variability between studies. Validation based on our local results showed similar yet slightly longer time frames. Timing of pseudophakic retinal detachment might direct appropriate follow-up, assisting in earlier detection.

Pseudophakic retinal detachment in young-aged patients

Objective

To investigate the incidence and risk factors for retinal detachment (RD) after cataract surgery or refractive lens exchange (RLE) in patients aged below 61 years.

Methods

Retrospective medical chart review of 7,886 patients (13,925 eyes) who underwent cataract surgery or RLE. Patients aged below 61 years were selected. Age, gender, axial length, follow-up times, and the occurrence of RD were recorded. Additional characteristics documented for RD cases were: history of RD, preexisting retinal findings, laser capsulotomy, status of macula at RD, date and details of RD.

Results

From a total of 421 patients (677 eyes) aged below 61 years 24 cases of RD were identified, resulting in an overall cumulative incidence per eyes of 3.55%. The mean follow-up time was 45 ± 32.8 months. Ninety-two % of all RDs occurred within 3.6 years from surgery. Axial length had a significant effect on the risk of RD after cataract/ RLE surgery (HR = 1.42, P = 0.0001, 95% CI 1.19–1.69). The highest incidence of RD occurred in the subgroup of 25 to 28.9 mm axial length (10.2%). With an increase in age of ten years, the hazard of postoperative RD was not significantly increased by a factor of 1.50 (P = 0.286, 95% CI 0.71–3.15). The highest incidence of RD occurred in patients aged 50–54 years (5.39%). Compared to females, males had an almost twofold not significant risk of postoperative RD (HR = 1.96, P = 0.123, 95% CI 0.83–4.63). None of the RD cases had a history of RD.

Conclusions

Axial length is a significant risk factor for pseudophakic RD. The need for cataract surgery or RLE should be carefully considered in patients with axial lengths between 25 and 29 mm, aged 50–54 years, in males, and in case of preexisting retinal findings.

Primary Repair of Moderate Severity Rhegmatogenous Retinal Detachment: A Critical Decision-Making Algorithm

We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery.

Bilateral Simultaneous Retinal Detachment in Pseudophakia

Cataract surgery is the most frequent surgical intervention, with approximately 700,000 operations per year in Germany alone. One of the most serious complications is retinal detachment, with a reported incidence rate of pseudophakic retinal detachment of 0.75–1.65%. We report the case of a patient who suffered from a simultaneous bilateral pseudophakic retinal detachment. Interestingly, the bilateral detachments in the left and the right eye started with only some hours' delay. He had no acute trigger for the retinal detachment and no risk factors besides the cataract surgery performed on both eyes some weeks earlier. Simultaneous bilateral retinal detachments will be more common, due to increasing numbers of cataract surgeries and the demographic development. We conclude that funduscopy should be regularly performed in mydriasis to avoid sight-threatening simultaneous bilateral retinal detachments.

Perioperative retina evaluation of the cataract surgery patient

PURPOSE OF REVIEW

To describe recent evidence regarding cataract surgery in patients with coexisting retinal disease, focusing on factors that are important to the perioperative evaluation and treatment of this patient population.

RECENT FINDINGS

Studies in patients with age-related macular degeneration have yielded good visual gains without progression of neovascular disease or increased need for intravitreal antivascular endothelial growth factor therapy. Uveitic patients similarly gain vision on average, and control of inflammation remains paramount. Perioperative treatment with intravitreal antivascular endothelial growth factor and corticosteroid help mitigate postoperative macular edema in patients with diabetic macular edema. Risk of retinal detachment is elevated postcataract surgery, but evidence regarding prophylactic treatment of peripheral retinal pathology is lacking. Intracameral antibiotics have reduced rates of postcataract surgery endophthalmitis in recent population-based retrospective studies.

SUMMARY

Favorable visual acuity outcomes are possible following cataract surgery in patients with retinal disease, including uveitis, diabetic macular edema, and age-related macular degeneration. Perioperative control of retinal disease activity is desired, but level 1 evidence to guide best practices regarding optimal timing and nature of perioperative treatment remains limited. Prevention of postoperative retinal detachment and endophthalmitis is deserving of additional study.

Spectral-domain optical coherence tomography imaging of macula-off rhegmatogenous retinal detachment

The timing of repair and the utility of spectral-domain optical coherence tomography (SD-OCT) for macula-off retinal detachment remains a controversial issue. Four patients who presented with macula-off retinal detachment underwent repair at various time points after symptom onset. Postoperative SD-OCT of the macula demonstrated correlation with final visual acuity.

Update on retinal detachment surgery

PURPOSE OF REVIEW

Update on controversies in the surgical management of rhegmatogenous retinal detachment.

RECENT FINDINGS

There are multiple new reports regarding the development and management of retinal detachment. Current use of oral fluoroquinolones may be associated with onset of retinal detachment, although the clinical relevance of this correlation is uncertain at this time and the finding has not been replicated in subsequent studies. Pars plana vitrectomy (PPV) continues to demonstrate efficacy as a primary treatment for retinal detachment, especially in pseudophakic patients. In many patients with macula-on retinal detachment, scheduling surgery after a short time delay is not necessarily deleterious and may actually be beneficial. Novel surgical tools, including bioerodible scleral buckling materials and artificial vitreous substitutes, are being investigated.

SUMMARY

Retinal detachment remains an important cause of visual loss. Although current surgical techniques demonstrate high rates of anatomic and visual success, further advances will probably benefit patients with retinal detachment.