- Email: [email protected]
Prognosis of pseudophakic retinal detachment
Prognosis of pseudophakic retinal detachment Ulrik Christensen, MD, Jørgen Villumsen, MD, DMSc Purpose: To compare preoperative and postoperative findings in phakic and pseudophakic patients operated on for rhegmatogenous retinal detachment (RD). Setting: Herlev University Hospital, Copenhagen, Denmark. Methods: This retrospective review comprised 120 pseudophakic patients and 280 phakic patients who had RD surgery during a 4-year period. An identical scleral buckling procedure was used for primary surgery in both groups. Cataract surgery had been performed using extracapsular cataract extraction (ECCE) in most eyes; phacoemulsification was used in 67.5% of the pseudophakic eyes. The mean follow-up was 13.5 months. Results: Pseudophakic patients with RDs presented with significantly worse preoperative visual acuity than phakic patients due to a higher frequency of total RDs and macula-off RDs. Retinal breaks were found significantly less frequently and reoperations were performed with a higher frequency in pseudophakic patients than in phakic patients. At 6 months, no differences between pseudophakic and phakic patients were found. The overall anatomic reattachment rate was 94% and 96% in the 2 groups, and the visual outcome was also identical, with a visual acuity better than 0.4 in about 60% of patients. Conclusions: Pseudophakic patients presented with more extended RDs and with the macula detached more frequently. Retinal breaks were found less frequently. Despite these findings, the anatomic and visual prognosis of pseudophakic detachments was identical to that of phakic detachments. J Cataract Refract Surg 2005; 31:354–358 ª 2005 ASCRS and ESCRS
R
etinal detachment (RD) has traditionally been considered a serious complication of cataract extraction, but with the introduction of small-incision, phaco-assisted cataract extraction, the risk for RD has been substantially reduced. An incidence of about 1 per 1000 to 2 per 1000 is reported in patients without preoperative or perioperative risk factors such as high axial length, previous eye disease, or posterior capsule rupture.1,2
Accepted for publication April 30, 2004. From the Department of Ophthalmology, Herlev University Hospital, Herlev, Denmark. Presented in part at the XXIst Congress of the European Society of Cataract and Refractive Surgeons, Munich, Germany, September 2003. Neither author has a proprietary or commercial interest in any product mentioned. Reprint requests to Ulrik Christensen, Ndr. Fasanvej 32, 2.th, DK2000 Frederiksberg, Denmark. E-mail: [email protected]. 2005 ASCRS and ESCRS Published by Elsevier Inc.
Although cataract extraction is now rarely complicated by RD, the prevalence of pseudophakic RD in the population of treated rhegmatogenous RDs has been consistent since the 1980s because of the increasing number of cataract extractions performed. Thus, about 30% of cases referred for RD surgery are pseudophakic.3,4 The prognosis of pseudophakic detachments since the introduction of phacoemulsification is not well known. There are several reports of visual results after the repair of pseudophakic RDs, but all deal with data from the 1970s and 1980s when extracapsular cataract extraction (ECCE) without phacoemulsification of the nucleus was introduced and the traditional intracapsular cataract extraction (ICCE) method was slowly disappearing. The most recent study8 reports a final visual acuity better than 0.5 in 47.2% of 254 pseudophakic eyes (59% ECCE, 41% ICCE). These results are the best to date for a pseudophakic population larger than 0886-3350/05/$-see front matter doi:10.1016/j.jcrs.2004.04.067
PSEUDOPHAKIC RETINAL DETACHMENT
50 patients. Other studies from 1981 to 1992 report visual acuities better than 0.5 in 41% to 47% after pseudophakic RD (13.7% to 90.0% ECCE).5–12 The characteristics and prognosis after phakic detachments have not been evaluated since To¨rnquist and To¨rnquist13 published a large population-based study in 1988. This study reported a final visual acuity better than 0.5 in 30% to 35% of phakic RDs. The current study reports and compares characteristics, surgical results, and prognosis of phakic and pseudophakic RDs in an unselected population of patients with rhegmatogenous RD operated on at Herlev University Hospital, Copenhagen, Denmark, during a 4-year period.
Patients and Methods Four hundred patients with rhegmatogenous RDs were operated on between January 1, 1998, and December 31, 2001; 120 were pseudophakic and the remaining 280, phakic. Patient records were retrospectively reviewed. The ocular history; preoperative characteristics such as age, sex, and eye; type of cataract surgery; preoperative visual acuity; intraocular pressure (IOP); detachment features; and operative data specifying the surgical procedure were collected for each patient. Follow-up data were obtained from the referring ophthalmologist no earlier than 6 months postoperatively and included best corrected visual acuity, information about the retinal status, and possible complications. The mean follow-up time was 13.5 months 6 10.4 (SD) for phakic and pseudophakic patients.
Surgical Techniques Pseudophakic and phakic RDs were operated on using an almost identical surgical technique: a scleral buckle and an encircling band, cryopexy of the break if found, drainage of subretinal fluid, and tamponade with intraocular perfluoropropane to normalize the IOP. Evaluation for retinal detachment in the macula area was done by biomicroscopy preoperatively. The macula was considered not detached when no obvious signs of detachment were seen by the examination and detached when signs of detachment were seen. Two surgeons treated the patients using the same technique. Intraocular surgery with vitrectomy and memTable 2.
Table 1.
Characteristics of the study population.
Group
Number of Patients
Phakic
280
Pseudophakic
120
Number (%) Men
Women
Mean Age (Y)
145 (51.8) 135 (48.2) 55.0 6 18.2 72 (60.0)
48 (40.0) 64.4 6 13.5
brane peeling was added in complicated cases with advanced evidence of proliferative vitreoretinopathy (PVR). The surgery was considered anatomically successful if the retina was reattached for at least 6 months.
Statistical Methods Analyses of group differences were performed using the chi-square test and the paired t test. The mean visual acuities were calculated as the geometric mean.
Results Epidemiology The general characteristics of the study population are shown in Table 1. A small but insignificant preponderance of male patients was found (P Z .112). Sixtyeight percent of the population was between 50 and 80 years of age when admitted to the hospital. The mean age was a little higher in pseudophakic patients (64.4 years) than in phakic patients (55.0 years). There was no predominance of right-eye (49.5%) or left-eye (50.5%) RDs. There were no significant differences between phakic patients and pseudophakic patients in the distribution of refractive errors before cataract extraction. Myopia greater than ÿ10.0 diopters (D) was seen in 9 (3.2%) phakic patients and 3 (2.5%) pseudophakic patients. Myopia of ÿ5.0 to ÿ10.0 D was seen in 43 (15.4%) phakic patients and 9 (7.5%) pseudophakic patients. No differences in high hyperopia were found; hyperopia higher than C5.0 D was seen in 3 (1.1%) phakic patients and 2 (1.6%) pseudophakic patients. The subsets of refractive errors are shown in Table 2.
Distribution of refractive errors before cataract surgery. Number of Eyes (%)
Group
Oÿ10 D
ÿ5 to ÿ10 D
ÿ2 to ÿ5 D
ÿ2 to D2 D
D2 to D5 D
OD5 D
Phakic
9 (3.2)
43 (15.4)
51 (18.2)
112 (40.0)
20 (7.1)
3 (1.1)
42 (15.0)
Pseudophakic
3 (2.5)
9 (7.5)
15 (12.5)
47 (39.2)
11 (9.2)
2 (1.6)
33 (27.5)
J CATARACT REFRACT SURG—VOL 31, FEBRUARY 2005
Not Known
355
PSEUDOPHAKIC RETINAL DETACHMENT
Table 3.
Characteristics of the RDs.
Group
1D2 Quadrants Detached*
3D4 Quadrants Detached*
Macula Low or High Detached*
Mean Duration of Macular Detachment, d
Phakic
211 (75.4)
69 (24.6)
161 (57.5)
43.8 (118.6)
24 (8.6)
82 (68.3)
38 (31.7)
80 (66.7)
33.7 (59.0)
27 (22.5)
Pseudophakic
Break Undetected*
*Number of eyes (%)
Extracapsular surgery with phacoemulsification of hard lens material had been performed in 81 (67.5%) pseudophakic patients; ECCE without phacoemulsification had been performed in 33 (27.5%) patients and ICCE, in 6 (5.0%) patients. A posterior chamber intraocular lens (IOL) had been implanted in 113 eyes and an anterior chamber IOL, in 7 eyes. Cataract extraction had been performed a mean of 3.5 years (range 5 days to 15 years) before the RD was first diagnosed. A neodymium:YAG laser capsulotomy had been performed before the RD in 33 patients (27.5%) (mean 3.0 years, range 1 day to 12 years). The preoperative characteristics of the RDs are shown in Table 3. The RD was limited to 1 and 2 quadrants in 211 (75.4%) phakic eyes and 82 (68.3%) pseudophakic eyes. Three and 4 quadrants were involved in 69 (24.6%) phakic eyes and 38 (31.7%) pseudophakic eyes; the difference was not statistically significant (P Z .146). Phakic and pseudophakic patients presented with different rates of macula detachment (P Z .107), but the difference was not significant. One hundred sixty-one (57.5%) phakic eyes and 80 (66.7%) pseudophakic eyes presented with evidence of macula detachment. The mean duration of the macula detachment was not significantly different between pseudophakic eyes (34 6 59 days) and phakic eyes (44 6 119 days) (P Z .486). Retinal breaks were detected less frequently in pseudophakic eyes than in phakic eyes (27 eyes [22.5%] and 34 eyes [8.6%], respectively) (P Z .0001). The Table 4.
types and distribution of retinal breaks in the 4 quadrants are shown in Table 4. Horseshoe tears and round atrophic holes were the most frequent types of retinal breaks found in phakic and pseudophakic eyes. The breaks were most commonly located in the superior temporal quadrant. Temporally located breaks were observed more often in phakic eyes (91.8%) than in pseudophakic eyes (56.6%) (P Z .09). Surgical Results Four hundred forty-seven RD procedures were performed, 311 in phakic eyes and 136 in pseudophakic eyes; 47 procedures were reoperations, performed more frequently in pseudophakic eyes (16 eyes, 13.3%) than in phakic eyes (26 eyes, 9.3%) (P Z .226) (Table 5). Complete retinal reattachment at least 6 months after the last procedure was achieved in 378 (94.5%) surgically treated cases. The anatomic success rates in the 2 groups were almost identical (phakic 93.9%, pseudophakic 95.8%). In phakic and pseudophakic eyes, a mean of 1.18 operations was needed to reattach the retina. Table 6 shows the preoperative visual acuity. Pseudophakic patients had significantly worse visual acuities on admission to the hospital than phakic patients. Visual acuity worse than 0.4 was seen in 83 (69.2%) pseudophakic eyes and 167 (59.7%) phakic eyes (P!.001). Visual acuity better than 0.4 was seen in 26.7% and 38.9%, respectively. The final best corrected visual acuity is shown in Table 7. It was better than
Type of break and distribution of retinal breaks in the 4 quadrants. Number of Eyes (%)
Group
Horseshoe Tears
Phakic Pseudophakic
Atrophic Holes
ST Located Breaks
SN Located Breaks
IT Located Breaks
157 (56.1)
58 (20.7)
168 (60.0)
81 (28.9)
89 (31.8)
41 (14.6)
72 (60.0)
14 (11.7)
49 (40.8)
34 (28.3)
19 (15.8)
17 (14.2)
IN Z inferior nasal quadrant; IT Z inferior temporal quadrant; SN Z superior nasal quadrant; ST Z superior temporal quadrant
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PSEUDOPHAKIC RETINAL DETACHMENT
Table 5.
Surgical methods (reoperations included).
Group
Total Number of Ops/Reops
Buckle*
Mean Size of Buckle Encircling Drainage Tamponade (Clock Hours) Band* Cryopexy* of SRF* with C3F8* Vitrectomy
Phakic
311/31
272 (87.5)
5.8 6 1.5
264 (84.9)
246 (79.1)
246 (79.1)
179 (57.6)
51 (16.4)
Pseudophakic
136/16
114 (83.3)
6.0 6 1.6
111 (81.6)
100 (73.5)
99 (72.8)
78 (54.4)
28 (20.6)
C3F8Zperfluoropropane *Number of eyes (%)
Table 6.
Preoperative visual acuity. Number of Eyes (%)
Group
!0.1
Phakic
0.4–0.7
O0.7
Not Known
114 (40.7) 53 (19.0) 39 (13.9) 70 (25.0) 4 (1.4)
Pseudophakic
Table 7.
0.1–0.4
61 (50.8) 22 (18.3)
9 (7.5) 23 (19.2) 5 (4.2)
Postoperative visual acuity. Number of Eyes (%)
Group
!0.1
Phakic
42 (15.0)
70 (25.0)
70 (25.0)
98 (35.0)
9 (7.5)
41 (34.2)
26 (21.6)
44 (36.7)
Pseudophakic
0.1–0.4
0.4–0.7
O0.7
0.4 in 58.3% of pseudophakic eyes and 60.0% of phakic eyes. The improvement in visual acuity was evident between preoperative and postoperative visual acuities.
Discussion This study presents a comparison of preoperative characteristics and surgical results in phakic and pseudophakic eyes with RD operated on by 2 surgeons over the same period of time. Operations were performed with an identical surgical technique; intraocular surgery was performed only for obvious PVR and indications for intraocular operation independent of phakic status. Four hundred forty-seven procedures for primary rhegmatogenous RD were performed. In most pseudophakic eyes (114, 95.0%), the cataract was extracted by ECCE; in 81 eyes (67.5%), phacoemulsification was used, and in 33 eyes (27.5%), it was not used. Thus, the pseudophakic cases in this study represent primarily the results of the small-incision surgical technique with phacoemulsification of the hard lens material. The overall anatomic success rate was 94.5%. There were no significant differences between phakic and pseudophakic eyes in the success rate even though RDs
were related to subtotal or total RDs (3 to 4 quadrants detached) more often in pseudophakic eyes than in phakic eyes. The frequency of no breaks was significantly higher in pseudophakic RDs than in phakic RDs. This is normally regarded as a poor prognostic factor for surgical results. Visual acuity was better than 0.4 in about 60% of cases. There was no significant between-group difference in postoperative visual acuity (P Z .67), although pseudophakic RDs presented with significantly poorer preoperative visual acuity than phakic RDs because of a higher frequency of macula detachments. There was no significant between-group difference in the duration of macular detachment. Our study indicates that previous ECCE may be associated with more extended RDs and more frequent macula detachments (P Z .146 and P Z .107, respectively). Despite these findings, the anatomic and visual prognoses of pseudophakic detachments are identical to those of phakic detachments.
References 1. Norregaard JC, Thoning H, Andersen TF, et al. Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study. Br J Ophthalmol 1996; 80:689–693 2. Boberg-Ans G, Villumsen J, Henning V. Retinal detachment after phacoemulsification cataract extraction. J Cataract Refract Surg 2003; 29:1333–1338 3. Gray RH, Evans AR, Constable IJ, McAllister IL. Retinal detachment and its relation to cataract surgery. Br J Ophthalmol 1989; 73:775–780 4. Girard P, Karpouzas I. Visual acuity after scleral buckling surgery. Ophthalmologica 1995; 209:323–328 5. Isernhagen RD, Wilkinson CP. Recovery of visual acuity following the repair of pseudophakic retinal detachment. Trans Am Ophthalmol Soc 1988; 86:291–303; discussion, 303–306 6. Greven CM, Sanders RJ, Brown GC, et al. Pseudophakic retinal detachments; anatomic and visual results. Ophthalmology 1992; 99:257–262
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PSEUDOPHAKIC RETINAL DETACHMENT
7. Yoshida A, Ogasawara H, Jalkh AE, et al. Retinal detachment after cataract surgery; surgical results. Ophthalmology 1992; 99:460–465 8. Yoshida A, Ogasawara H, Jalkh AE, et al. Retinal detachment after cataract surgery; predisposing factors. Ophthalmology 1992; 99:453–459 9. Wilkinson CP. Pseudophakic retinal detachments. Retina 1985; 5:1–4 10. Wilkinson CP. Retinal detachments following intraocular lens implantation. Ophthalmology 1981; 88: 410–413
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11. Cousins S, Boniuk I, Okun E, et al. Pseudophakic retinal detachments in the presence of various IOL types. Ophthalmology 1986; 93:1198–1207; discussion by CP Wilkinson, 1207–1208 12. Ho PC, Tolentino FI. Pseudophakic retinal detachment; surgical success rate with various types of IOLs. Ophthalmology 1984; 91:847–852 13. To¨rnquist R, To¨rnquist P. Retinal detachment; a study of a population-based patient material in Sweden 19711981. III. Surgical results. Acta Ophthalmol 1988; 66: 630–636
J CATARACT REFRACT SURG—VOL 31, FEBRUARY 2005
R
etinal detachment (RD) has traditionally been considered a serious complication of cataract extraction, but with the introduction of small-incision, phaco-assisted cataract extraction, the risk for RD has been substantially reduced. An incidence of about 1 per 1000 to 2 per 1000 is reported in patients without preoperative or perioperative risk factors such as high axial length, previous eye disease, or posterior capsule rupture.1,2
Accepted for publication April 30, 2004. From the Department of Ophthalmology, Herlev University Hospital, Herlev, Denmark. Presented in part at the XXIst Congress of the European Society of Cataract and Refractive Surgeons, Munich, Germany, September 2003. Neither author has a proprietary or commercial interest in any product mentioned. Reprint requests to Ulrik Christensen, Ndr. Fasanvej 32, 2.th, DK2000 Frederiksberg, Denmark. E-mail: [email protected]. 2005 ASCRS and ESCRS Published by Elsevier Inc.
Although cataract extraction is now rarely complicated by RD, the prevalence of pseudophakic RD in the population of treated rhegmatogenous RDs has been consistent since the 1980s because of the increasing number of cataract extractions performed. Thus, about 30% of cases referred for RD surgery are pseudophakic.3,4 The prognosis of pseudophakic detachments since the introduction of phacoemulsification is not well known. There are several reports of visual results after the repair of pseudophakic RDs, but all deal with data from the 1970s and 1980s when extracapsular cataract extraction (ECCE) without phacoemulsification of the nucleus was introduced and the traditional intracapsular cataract extraction (ICCE) method was slowly disappearing. The most recent study8 reports a final visual acuity better than 0.5 in 47.2% of 254 pseudophakic eyes (59% ECCE, 41% ICCE). These results are the best to date for a pseudophakic population larger than 0886-3350/05/$-see front matter doi:10.1016/j.jcrs.2004.04.067
PSEUDOPHAKIC RETINAL DETACHMENT
50 patients. Other studies from 1981 to 1992 report visual acuities better than 0.5 in 41% to 47% after pseudophakic RD (13.7% to 90.0% ECCE).5–12 The characteristics and prognosis after phakic detachments have not been evaluated since To¨rnquist and To¨rnquist13 published a large population-based study in 1988. This study reported a final visual acuity better than 0.5 in 30% to 35% of phakic RDs. The current study reports and compares characteristics, surgical results, and prognosis of phakic and pseudophakic RDs in an unselected population of patients with rhegmatogenous RD operated on at Herlev University Hospital, Copenhagen, Denmark, during a 4-year period.
Patients and Methods Four hundred patients with rhegmatogenous RDs were operated on between January 1, 1998, and December 31, 2001; 120 were pseudophakic and the remaining 280, phakic. Patient records were retrospectively reviewed. The ocular history; preoperative characteristics such as age, sex, and eye; type of cataract surgery; preoperative visual acuity; intraocular pressure (IOP); detachment features; and operative data specifying the surgical procedure were collected for each patient. Follow-up data were obtained from the referring ophthalmologist no earlier than 6 months postoperatively and included best corrected visual acuity, information about the retinal status, and possible complications. The mean follow-up time was 13.5 months 6 10.4 (SD) for phakic and pseudophakic patients.
Surgical Techniques Pseudophakic and phakic RDs were operated on using an almost identical surgical technique: a scleral buckle and an encircling band, cryopexy of the break if found, drainage of subretinal fluid, and tamponade with intraocular perfluoropropane to normalize the IOP. Evaluation for retinal detachment in the macula area was done by biomicroscopy preoperatively. The macula was considered not detached when no obvious signs of detachment were seen by the examination and detached when signs of detachment were seen. Two surgeons treated the patients using the same technique. Intraocular surgery with vitrectomy and memTable 2.
Table 1.
Characteristics of the study population.
Group
Number of Patients
Phakic
280
Pseudophakic
120
Number (%) Men
Women
Mean Age (Y)
145 (51.8) 135 (48.2) 55.0 6 18.2 72 (60.0)
48 (40.0) 64.4 6 13.5
brane peeling was added in complicated cases with advanced evidence of proliferative vitreoretinopathy (PVR). The surgery was considered anatomically successful if the retina was reattached for at least 6 months.
Statistical Methods Analyses of group differences were performed using the chi-square test and the paired t test. The mean visual acuities were calculated as the geometric mean.
Results Epidemiology The general characteristics of the study population are shown in Table 1. A small but insignificant preponderance of male patients was found (P Z .112). Sixtyeight percent of the population was between 50 and 80 years of age when admitted to the hospital. The mean age was a little higher in pseudophakic patients (64.4 years) than in phakic patients (55.0 years). There was no predominance of right-eye (49.5%) or left-eye (50.5%) RDs. There were no significant differences between phakic patients and pseudophakic patients in the distribution of refractive errors before cataract extraction. Myopia greater than ÿ10.0 diopters (D) was seen in 9 (3.2%) phakic patients and 3 (2.5%) pseudophakic patients. Myopia of ÿ5.0 to ÿ10.0 D was seen in 43 (15.4%) phakic patients and 9 (7.5%) pseudophakic patients. No differences in high hyperopia were found; hyperopia higher than C5.0 D was seen in 3 (1.1%) phakic patients and 2 (1.6%) pseudophakic patients. The subsets of refractive errors are shown in Table 2.
Distribution of refractive errors before cataract surgery. Number of Eyes (%)
Group
Oÿ10 D
ÿ5 to ÿ10 D
ÿ2 to ÿ5 D
ÿ2 to D2 D
D2 to D5 D
OD5 D
Phakic
9 (3.2)
43 (15.4)
51 (18.2)
112 (40.0)
20 (7.1)
3 (1.1)
42 (15.0)
Pseudophakic
3 (2.5)
9 (7.5)
15 (12.5)
47 (39.2)
11 (9.2)
2 (1.6)
33 (27.5)
J CATARACT REFRACT SURG—VOL 31, FEBRUARY 2005
Not Known
355
PSEUDOPHAKIC RETINAL DETACHMENT
Table 3.
Characteristics of the RDs.
Group
1D2 Quadrants Detached*
3D4 Quadrants Detached*
Macula Low or High Detached*
Mean Duration of Macular Detachment, d
Phakic
211 (75.4)
69 (24.6)
161 (57.5)
43.8 (118.6)
24 (8.6)
82 (68.3)
38 (31.7)
80 (66.7)
33.7 (59.0)
27 (22.5)
Pseudophakic
Break Undetected*
*Number of eyes (%)
Extracapsular surgery with phacoemulsification of hard lens material had been performed in 81 (67.5%) pseudophakic patients; ECCE without phacoemulsification had been performed in 33 (27.5%) patients and ICCE, in 6 (5.0%) patients. A posterior chamber intraocular lens (IOL) had been implanted in 113 eyes and an anterior chamber IOL, in 7 eyes. Cataract extraction had been performed a mean of 3.5 years (range 5 days to 15 years) before the RD was first diagnosed. A neodymium:YAG laser capsulotomy had been performed before the RD in 33 patients (27.5%) (mean 3.0 years, range 1 day to 12 years). The preoperative characteristics of the RDs are shown in Table 3. The RD was limited to 1 and 2 quadrants in 211 (75.4%) phakic eyes and 82 (68.3%) pseudophakic eyes. Three and 4 quadrants were involved in 69 (24.6%) phakic eyes and 38 (31.7%) pseudophakic eyes; the difference was not statistically significant (P Z .146). Phakic and pseudophakic patients presented with different rates of macula detachment (P Z .107), but the difference was not significant. One hundred sixty-one (57.5%) phakic eyes and 80 (66.7%) pseudophakic eyes presented with evidence of macula detachment. The mean duration of the macula detachment was not significantly different between pseudophakic eyes (34 6 59 days) and phakic eyes (44 6 119 days) (P Z .486). Retinal breaks were detected less frequently in pseudophakic eyes than in phakic eyes (27 eyes [22.5%] and 34 eyes [8.6%], respectively) (P Z .0001). The Table 4.
types and distribution of retinal breaks in the 4 quadrants are shown in Table 4. Horseshoe tears and round atrophic holes were the most frequent types of retinal breaks found in phakic and pseudophakic eyes. The breaks were most commonly located in the superior temporal quadrant. Temporally located breaks were observed more often in phakic eyes (91.8%) than in pseudophakic eyes (56.6%) (P Z .09). Surgical Results Four hundred forty-seven RD procedures were performed, 311 in phakic eyes and 136 in pseudophakic eyes; 47 procedures were reoperations, performed more frequently in pseudophakic eyes (16 eyes, 13.3%) than in phakic eyes (26 eyes, 9.3%) (P Z .226) (Table 5). Complete retinal reattachment at least 6 months after the last procedure was achieved in 378 (94.5%) surgically treated cases. The anatomic success rates in the 2 groups were almost identical (phakic 93.9%, pseudophakic 95.8%). In phakic and pseudophakic eyes, a mean of 1.18 operations was needed to reattach the retina. Table 6 shows the preoperative visual acuity. Pseudophakic patients had significantly worse visual acuities on admission to the hospital than phakic patients. Visual acuity worse than 0.4 was seen in 83 (69.2%) pseudophakic eyes and 167 (59.7%) phakic eyes (P!.001). Visual acuity better than 0.4 was seen in 26.7% and 38.9%, respectively. The final best corrected visual acuity is shown in Table 7. It was better than
Type of break and distribution of retinal breaks in the 4 quadrants. Number of Eyes (%)
Group
Horseshoe Tears
Phakic Pseudophakic
Atrophic Holes
ST Located Breaks
SN Located Breaks
IT Located Breaks
157 (56.1)
58 (20.7)
168 (60.0)
81 (28.9)
89 (31.8)
41 (14.6)
72 (60.0)
14 (11.7)
49 (40.8)
34 (28.3)
19 (15.8)
17 (14.2)
IN Z inferior nasal quadrant; IT Z inferior temporal quadrant; SN Z superior nasal quadrant; ST Z superior temporal quadrant
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PSEUDOPHAKIC RETINAL DETACHMENT
Table 5.
Surgical methods (reoperations included).
Group
Total Number of Ops/Reops
Buckle*
Mean Size of Buckle Encircling Drainage Tamponade (Clock Hours) Band* Cryopexy* of SRF* with C3F8* Vitrectomy
Phakic
311/31
272 (87.5)
5.8 6 1.5
264 (84.9)
246 (79.1)
246 (79.1)
179 (57.6)
51 (16.4)
Pseudophakic
136/16
114 (83.3)
6.0 6 1.6
111 (81.6)
100 (73.5)
99 (72.8)
78 (54.4)
28 (20.6)
C3F8Zperfluoropropane *Number of eyes (%)
Table 6.
Preoperative visual acuity. Number of Eyes (%)
Group
!0.1
Phakic
0.4–0.7
O0.7
Not Known
114 (40.7) 53 (19.0) 39 (13.9) 70 (25.0) 4 (1.4)
Pseudophakic
Table 7.
0.1–0.4
61 (50.8) 22 (18.3)
9 (7.5) 23 (19.2) 5 (4.2)
Postoperative visual acuity. Number of Eyes (%)
Group
!0.1
Phakic
42 (15.0)
70 (25.0)
70 (25.0)
98 (35.0)
9 (7.5)
41 (34.2)
26 (21.6)
44 (36.7)
Pseudophakic
0.1–0.4
0.4–0.7
O0.7
0.4 in 58.3% of pseudophakic eyes and 60.0% of phakic eyes. The improvement in visual acuity was evident between preoperative and postoperative visual acuities.
Discussion This study presents a comparison of preoperative characteristics and surgical results in phakic and pseudophakic eyes with RD operated on by 2 surgeons over the same period of time. Operations were performed with an identical surgical technique; intraocular surgery was performed only for obvious PVR and indications for intraocular operation independent of phakic status. Four hundred forty-seven procedures for primary rhegmatogenous RD were performed. In most pseudophakic eyes (114, 95.0%), the cataract was extracted by ECCE; in 81 eyes (67.5%), phacoemulsification was used, and in 33 eyes (27.5%), it was not used. Thus, the pseudophakic cases in this study represent primarily the results of the small-incision surgical technique with phacoemulsification of the hard lens material. The overall anatomic success rate was 94.5%. There were no significant differences between phakic and pseudophakic eyes in the success rate even though RDs
were related to subtotal or total RDs (3 to 4 quadrants detached) more often in pseudophakic eyes than in phakic eyes. The frequency of no breaks was significantly higher in pseudophakic RDs than in phakic RDs. This is normally regarded as a poor prognostic factor for surgical results. Visual acuity was better than 0.4 in about 60% of cases. There was no significant between-group difference in postoperative visual acuity (P Z .67), although pseudophakic RDs presented with significantly poorer preoperative visual acuity than phakic RDs because of a higher frequency of macula detachments. There was no significant between-group difference in the duration of macular detachment. Our study indicates that previous ECCE may be associated with more extended RDs and more frequent macula detachments (P Z .146 and P Z .107, respectively). Despite these findings, the anatomic and visual prognoses of pseudophakic detachments are identical to those of phakic detachments.
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