Are all primary retinal detachments the same? Anatomic and functional differences between phakic and pseudophakic patients.

BACKGROUND: Given differences in the pathogenic mechanisms underlying primary retinal detachment (RD) as a function of the status of the lens, the objective was to explore differences between pseudophakic and phakic patients with primary RD. METHODS: A retrospective study including 821 patients who underwent surgery for RD [491 cases of phakic and 330 of pseudophakic RD (pRD and psRD, respectively)] in our hospital between 2012 and 2020. RESULTS: The mean age was 58.24 ± 12.76 years in the pRD group and 66.87 ± 11.18 years in the psRD group (p = 0.001). There were more men in both groups (70% and 64.23% of pseudophakic and phakic patients, respectively; p = 0.07). The most common location for the RD was superior in both groups (43.94% and 51.93% of pseudophakic and phakic patients, respectively), rates of inferior and total RD were somewhat higher in the psRD group (31.82% and 13.33% in pseudophakic vs 25.25% and 11.0% in phakic patients, p = 0.001). In pseudophakic and phakic patients respectively, macular involvement in 69.09% and 62.73% of cases (p = 0.067). Proliferative vitreoretinopathy was significantly more common in the psRD group (7.88% vs 3.6% in phakic patients, p = 0.01).The rate of final anatomic reattachment differed markedly between groups, with a higher rate in phakic (94.03%) than pseudophakic (87.27%) patients (p = 0.001). CONCLUSIONS: The specific pathogenic mechanism involved in psRD seems to be responsible for worse evolution characteristics which are associated with poorer final anatomic and functional outcomes in pseudophakic patients.

Factores asociados al desprendimiento de retina pseudofáquico: seguimiento a largo plazo en una población colombiana / Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population

Objetivo Identificar factores asociados a la aparición de desprendimiento de retina pseudofáquico en pacientes con antecedente de cirugía de catarata. Métodos Estudio retrospectivo de casos y controles de 802 ojos de 783 pacientes con antecedente de cirugía de catarata. Los casos fueron pacientes con desprendimiento de retina pseudofáquico (n=258 ojos), mientras que los controles fueron pacientes con cirugía de cataratas que no desarrollaron desprendimiento de retina durante un período de seguimiento de 10 años (n=544 ojos). Resultados La edad de la cirugía de cataratas entre los casos fue menor que en el grupo control (57±13 vs. 67±14 años, respectivamente; p<0,0001). La edad al desprendimiento de retina fue de 59±13 años (rango 6-88) y el tiempo entre la cirugía de catarata y el desprendimiento de retina tuvo una mediana de 2 años (rango intercuartílico 1-4), con un rango de un mes a 14 años. Los factores asociados para el desprendimiento de retina pseudofáquico fueron la edad más joven (<50 años: razón de probabilidad ajustada [ORa]=18,03; intervalo de confianza del 95% [IC 95%]=5,92-54,87; 50-59 años: ORa=10,09, IC 95%=3,37-30,23 y 60-69 años: ORa=5,48, IC 95%=1,88-15,93), sexo masculino (ORa=3,71, IC 95%=2,54-5,44), vitrectomía anterior (ORa=3,26, IC 95%=1,16-9,16), antecedentes de desprendimiento de retina en el ojo contralateral (ORa=6,95, IC 95%=3,15-15,31) y complicaciones intraoperatorias durante la extracción de cataratas (ORa=7,45, IC 95%=3,54-15,69). Conclusiones Este es el primer artículo de factores asociados al desprendimiento de retina pseudofáquico en población colombiana. Se encontró que las complicaciones quirúrgicas, el sexo y la edad estaban asociados con el desprendimiento de retina. Los pacientes deben ser conscientes de estos riesgos potenciales para tomar decisiones informadas sobre su salud ocular (AU)

Objective To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. Methods Retrospective case–control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n=258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n=544 eyes). Results Age at cataract surgery among cases was lower than in the control group (57±13 vs. 67±14 years old, respectively; P<.0001). Age at retinal detachment was 59±13 years old (range 6–88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1–4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR]=18.03, 95% confidence interval [95% CI]=5.92–54.87; 50–59 years: aOR=10.09, 95% CI=3.37–30.23; and 60–69 years: aOR=5.48, 95% CI=1.88–15.93), male sex (aOR=3.71, 95% CI=2.54–5.44), anterior vitrectomy (aOR=3.26, 95% CI=1.16–9.16), history of retinal detachment in the fellow eye (aOR=6.95, 95% CI=3.15–15.31), and intraoperative complications during cataract extraction (aOR=7.45, 95% CI=3.54–15.69). Conclusions This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health (AU)

Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population.

OBJECTIVE: To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery. METHODS: Retrospective case-control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes). RESULTS: Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; p < 0.0001). Age at retinal detachment was 59 ± 13 years old (range 6-88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1-4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (<50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95%CI] = 5.92-54.87; 50-59 years: aOR = 10.09, 95%CI = 3.37-30.23; and 60-69 years: aOR = 5.48, 95%CI = 1.88-15.93), male sex (aOR = 3.71, 95%CI = 2.54-5.44), anterior vitrectomy (aOR = 3.26, 95%CI = 1.16-9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95%CI = 3.15-15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95%CI = 3.54-15.69). CONCLUSIONS: This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.

Retinal detachment after phacoemulsification in refractive surgery clinics: a large series analysis with variable follow-up during 16 years.

PURPOSE: To determine the long-term incidence of pseudophakic retinal detachment (PRD) after phacoemulsification and the weight of the main risk factors in the appearance of such complication in a large sample. To implement a customized formula and a software calculation program able to quantify the risk of suffering PRD applicable to all lens extraction patients. METHODS: Retrospective cumulative risk analysis conducted on 178,515 eyes operated under similar conditions in a group of refractive surgery clinics (Clínica Baviera SL) located in a relatively limited geographical area (Spain). A survival analysis was performed and the data were modelled using the Weibull regression to determine the risk over a period of 16 years and to estimate the association of different risk factors: sex, age, axial length (AXL) of the eye, intraoperative posterior capsule rents (PCR), and YAG laser capsulotomies. The resulting estimates were translated into a predictive equation for hazard rates and survival probabilities. Later, an application was developed to make prediction available for the clinical community in order to estimate the potential risk of any hypothetical case before lens surgery. RESULTS: Globally, 1521 (0.85%) cases of PRD were diagnosed during the period. The risk for PRD was significantly greater in males (5.48 [2.94-10.2]; p < 0.001), in long eyes (1.24 [1.21-1.26]; p < 0.001), and also after posterior capsule rents (13.97 [11.61-16.82]; p < 0.001). Posterior capsule rupture increased the risk of PRD up to fourteen times. CONCLUSIONS: From weaker to stronger impact, age, axial length, sex, and intraoperative posterior capsule rent were significant risk factors for the appearance of PRD after lens extraction.

Pseudophakic rhegmatogenous retinal detachment: combined pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone.

PURPOSE: To compare the outcomes of combined vitrectomy + scleral buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD). METHODS: Cases included 65 eyes of 63 patients with primary non-complex pseudophakic RRD. The first group underwent combined vitrectomy + SB between January 2010 and August 2012, and the second group was treated with vitrectomy alone between September 2012 and October 2013. The medical records of the patients were reviewed for preoperative examinations, follow-up examinations (including final visual acuity [VA]), appearance of redetachment and complications. The main outcomes were recurrent retinal detachment, complications, and VA improvement. RESULTS: The rate of single-surgery anatomic success was non-significantly lower in the combined vitrectomy + SB group compared with the vitrectomy alone group - 75.8 % versus 84.4 % respectively (P = 0.683). Complications were significantly more frequent in the former compared to the latter (P = 0.014). The final VAs were 0.580 (logMAR) and 0.486, respectively (P = 0.258). VA improvement of ≥3 lines was achieved in 48.5 % and in 50 % of the eyes respectively (P = 0.769). CONCLUSIONS: There were no significant differences in single-surgery anatomic success rates and VA improvement between combined vitrectomy + SB and vitrectomy alone for pseudophakic RRD. Significantly more complications occurred in the combination group.

Comparison of four surgical techniques for management of pseudophakic and aphakic retinal detachment: a multicenter clinical trial.

PURPOSE: To compare the visual and anatomical outcomes of four surgical techniques to manage pseudophakic and aphakic retinal detachment (PARD). METHODS: In a multicenter randomized clinical trial, 211 eyes of 211 patients with PARD and proliferative vitreoretinopathy (PVR) grade B or less were randomly assigned to one of the four treatment groups: (1) scleral buckling (SB), 50 eyes, (2) vitrectomy without band, 51 eyes, (3) vitrectomy with encircling band (EB), 58 eyes, and (4) triamcinolone acetonide (TA) assisted vitrectomy, 52 eyes. Patients were followed for 12 months after the surgery. The best-corrected visual acuity (BCVA) and retinal reattachment rate at each follow-up time point were considered as the primary outcome measures. PVR, macular pucker, and cystoid macular edema were considered as the secondary outcomes. RESULTS: Visual improvement was achieved in all treatment groups relative to the baseline at all time points (all Ps < 0.001). There were no statistically significant differences among the groups with regard to BCVA changes. However, there was a significant difference in the slope of visual improvement curve: the SB group had a more rapid visual improvement compared to the vitrectomy with buckle group at month 12 (P = 0.032). The retinal reattachment rates at month 12 were 75, 64.7, 68.5, and 66.7 % in SB, vitrectomy without buckle, vitrectomy with EB, and TA-assisted vitrectomy groups respectively (P > 0.99). There were no statistically significant differences among the groups in terms of adverse events. CONCLUSIONS: SB, TA-assisted vitrectomy, and vitrectomy with and without buckle had comparable outcomes in the management of PARD.

A Result of Pneumatic Retinopexy for Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical effectiveness of pneumatic retinopexy as a treatment method for pseudophakic retinal detachment. METHODS: A retrospective chart review was conducted of medical records of 38 patients who underwent pneumatic retinopexy using SF6 gas from January 2003 to December 2011 and who were observed during a follow-up period longer than 6 months. Primary and final success rates and final visual acuity were analyzed. Primary success was defined as retinal attachment at the last visit without additional surgery. Final success was defined as retinal reattachment at the last visit regardless of additional surgery. RESULTS: The mean patient age was 58.47 ± 17.00 years. All retinal tears were located in the upper retina (from 8 to 4 o'clock). Preoperative mean visual acuity was 1.17 ± 1.00 log MAR, and postoperative mean visual acuity was 0.42 ± 0.48 log MAR. The primary success rate was 61%, and patients with re-detached retina underwent repeat pneumatic retinopexy or other surgery such as scleral buckling or pars plana vitrectomy. At the final visit, all of the patients demonstrated successful results. CONCLUSIONS: Pneumatic retinopexy does not result in strabismus or refractive error, and the final success rate was 66% in our study. Therefore, pneumatic retinopexy can be considered as an effective management technique for some pseudophakic retinal detachment patients.

Clinical Results between Scleral Buckling and Vitrectomy in Pseudophakic Retinal Detachment with Intact Posterior Capsule

PURPOSE: To compare the clinical outcomes between scleral buckling and vitrectomy in the primary management of pseudophakic retinal detachment with an intact posterior capsule. METHODS: The medical records of 63 eyes that underwent scleral buckling (36 eyes) or vitrectomy (27 eyes) as a primary operation of uncomplicated pseudophakic retinal detachment with intact posterior capsules with a follow-up of more than one year were retrospectively reviewed from 2000 to 2005. We compared the clinical outcomes using anatomical and functional success rates at postoperative one year. Anatomical success was defined by a reattachment rate and functional success was measured by a change of more than 0.3 logMAR. RESULTS: Anatomical success rates were 86% in the scleral buckling and 82% in the vitrectomy, respectively (p=0.837). Functional success rates were 81% in the scleral buckling and 70% in the vitrectomy, respectively (p=0.065). There were no significant differences of anatomical and functional success rates according to each surgical procedure. CONCLUSIONS: Either scleral buckling or vitrectomy may be chosen as a primary operation in the management of pseudophakic retinal detachment with intact posterior capsule.

Onset of Retinal Detachment in Eyes with Phacoemulsification and Posterior Chamber Lens Implantaton

PURPOSE: To evaluate the onset of retinal detachment (RD) in eyes with phacoemulsification and post chamber lens (PE & PCL) implantation. METHODS: We retrospectively analyzed 3023 eyes that had undergone clear cornea incision and PE and PCL implantation and 116 eyes that had undergone scleral incision and PE and PCL implantation. They had been operated from January 1995 to December 2000 by one surgeon and followed up for 4 years or more. RESULTS: Eighteen eyes (0.57%) of the 3139 eyes developed pseudophakic RD within a mean period of 663 days. In the scleral incision group, there were 4 cases of pseudophakic RD (3.4%) of 116 eyes developed in a mean period of 185.2 days. In the clear cornea group, there were 14 pseudophakic RD eyes (0.46%) of the 3023 eyes and the mean period was 799 days. Of these, 3 eyes made up the intraoperative complication group with a mean period 205.6 days. But in the group of cases with no intraoperative complications, the mean period was 962 days. CONCLUSIONS: In high myopic eyes, retinal detachment developed in the earlier postoperative period and at a higher rate than those of non-high myopic eyes after PE and PCL implantation.

Clinical Characteristics and Surgical Outcomes of Pseudophakic and Aphakic Retinal Detachments

We retrospectively evaluated the clinical characteristics and surgical outcomes of 20 pseudophakic retinal detachment (RD) patients (20 eyes) and 17 aphakic RD patients (17 eyes). Males were predominated in both groups. The time interval between cataract extraction and RD was 31 months on average in the pseudophakic group, 32 months with intact posterior capsule and 27 months with ruptured posterior capsule, and 148 months in the aphakic group. In 50% of cases with ruptured posterior capsule in the pseudophakic group, RD occurred within 1 year. The anatomic success rate was 95% in the pseudophakic group and 88% in the aphakic group. The most common cause of failure was the development of proliferative vitreoretinopathy. Visual acuities more than 20/40 after RD surgery were found in 13 pseudophakic (65%) and 6 aphakic (36%) eyes. Aphakic patients were more inclined to have silent RD than pseudophakic patients because of their poor visual acuity. Post-operative follow-up is required especially for the first 1 year in cases of damaged posterior capsule due to the high incidence of RD during this period.

Clinical Evaluation of Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical characteristics of pseudophakic retinal detachment(RD) as RD is the most common sight-threatening complication after cataract surgery. METHODS: We analysed retrospectively the clinical characteristics of 22 pseudophakic RD patiens(23 eyes) which had been operated from January 1993 to December 1997 and followed for 6 months or longer at the Gyeongsang National University Hospital. RESULTS: The average age of the patients was sixty-three and male predominated 19 eyes(82.6%). According as types of IOL implantation included 14 eyes with posterior chamber IOL, 7 eyes with sclera-fixated IOL, 2 eyes with anterior chamber IOL, and 16 eyes(70%) occurred the posterior casule rupture. The interval between IOL implantation and the development of RD was 9.6 months on average and 78% of eyes developed RD within 1 year. In eyes with sclera-fixated IOL, the interval was shorter than others, In cases with ruptured posterior capsule, RD occurred earlier than those with intact posterior capsule. Retinal breaks were principally located in the upper quadrants in 12 eyes(63%) and horseshoe tear was most commmonly encountered. RD involving 3 or more quadrants was observed in 12 eyes(51%) of patients, and macular detachment in 18 eyes(78%). Anatomic success achieved in 83%. The most common cause of the failure was the development of proliferative vitreoretinopathy. Visual results in eyes with ultimate anatomic success of RD repair improved 0.5 or more in 80% if the macula was not involved and in 14.2% if the macula was involved. CONCLUSION: We thought that thorough fundus examination is neccessary during the follow-up of pseudophakic eye with posterior capsule rupture and sclera-fixated IOL after cataract surgery.

Pseudophakic/Aphakic Retinal Detachment Surgery Using Scleral Depression Technique

In aphakic/pseudophakic retinal detachments, difficulty in visualizing the peripheral retina and perhaps higher incidence of proliferative vitreoretinopathy result in lower success rate than phakic retinal detachment. We performed pars plana vitrectomy on 20 eyes with aphakic/pseudophakic retinal detachment. In most cases, we combined scleral bucking or encircling procedure. Using scleral depression technique, we found retinal breaks, dissected the vitreous base meticulously, and removed the vitreoretinal tractions. Intraoperatively, we were able to find retinal breaks in 12 eyes in which retinal breaks were not identified preoperatively, and identify additional retinal breaks in 3 of the remaining 8 eyes. We obtained anatomical success in all eyes and favorable visual acuity of better than 0.025 in 16 eyes (80%). These results suggest that finding all retinal breaks and removing vitreoretinal tractions are directly related to the improvernent of the surgical results.

Comparision of Clinical Findings between Phakic Retinal and Pseudophakic Retinal Detachment

We reviewed our medical records of primary retnal detachment(239 patients, 243 eyes) to compare the clincal findings of phakic retinal detachment(206 eyes) and pseudophakic retinal detachment(37 eyes). Pseudophakic retinal detachment was more common in male(73.0%) than in female(27.0%) and occurred more frequently in aged 60 years or more than phakic retinal detachment(10.4%)(P<0.001). Associated ocular finding such as high myopia(35.0%), peripheral retinal degeneration(23.3%0, retinal tear in fellow eye(5.8%) were more commonly seen in phakic retinal retinal detachment. Rupture of posterior capsule(40.5%), high myopia(18.9%), small pupil(13.5%) were associate with pseudophakic retinal detachment. In pseudophakic retinal detachment, more than 3 quadrant retinal detachment(73.0%) and macular involvement(78.4%) were more common than in phakic retinal detachment(P<0.01), but atropic hole(29.7%), or 2 or more retinal break(10.8%) were less common than in phakic retinal detachment(P<0.01) where the success rate of first operation(59.5%) and the overall success rate(81.1%) were lower in paeudophakic retinal detachment than phakic retinal detachment. The degree of visual recovery was nearly equal between two.

Characteristics of Retinal Detachment in Pseudophakic Eyes

To evauate the clinical characteristics of pseudophakic retinal detachments, 20 eyes were reviewed retrospectively. We identified the following characteristics of pseudophakic retinal detachment ; age in period of 40 (35%) and 60(30%), male(65%), rupture of posterior capsule (intraoperative and YAG laser capsulotomy)(50%). 15(75%) of the 20 pseduophakic retinal detachment eyes occured within 24months from the time of cataract surgery. Within 6 months after cataract surgery, the incidence of retinal detachment after posterior capsule rupture was higher than after uncomplicated cataract surgery, but there was no statistical significance. Retinal breaks were not detected in 7 eyes(35%). Retinal breaks were principally located in the upper quadrant in 6 eyes, horsehoe tear and atropic hole were most commonly encountered. More than 3 quadrant retinal detachment was observed in 80% of patients at the time of presentation and macular detachment, in 75%, Anatomic success rates were 85%. All of the failures were due to proliferative vitreoretinopathy.