|Year : 1981 | Volume
| Issue : 4 | Page : 363-365
Retinal detachment after cataract extraction
Mary Nalini Abraham, Sita Tatapudi, SS Badrinath
Medical Research Foundation, Madras, India
Mary Nalini Abraham
Medical Research Foundation, 18 College Road, Madras 600006
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Abraham MN, Tatapudi S, Badrinath S S. Retinal detachment after cataract extraction. Indian J Ophthalmol 1981;29:363-5
|How to cite this URL:|
Abraham MN, Tatapudi S, Badrinath S S. Retinal detachment after cataract extraction. Indian J Ophthalmol [serial online] 1981 [cited 2020 Apr 10];29:363-5. Available from: http://www.ijo.in/text.asp?1981/29/4/363/30932
This is an analytical study of 19 cases which developed retinal detachment after cataract extraction.
| Material and methods|| |
The study is retrospective and comprises of 19 patients (1.9%) who developed a retinal detachment out of 987 who underwent cataract surgery over a period of 7 years (1971-78 June), by a single surgeon. Cases where retinal detachment was detected or strongly suspected prior to cataract surgery were eliminated. The 19 patients in our series had the following characteristics :
(1) Aphakia as a result of extraction of senile cataract
(2) Presence of clinical rhegmatogenous retinal detachment
(3) Absence of trauma
(4) Absence of previous retinal surgery
15 patients were males and 4 females. Their age varying from 40-80 years. The maximum number of cataract extractions were on patients between 61 and 70 years. [Table - 1] Most of the cataracts were immature. Two were mature and one hypermature. The extraction was intracapsular in 871 cases and extracapsular in 100. In 16 cases, an extracapsular was converted into intracapsular. Alpha chymotrypsin was used in 89 cases. Vitreous was lost in 42 cases. The refractive status of the patient was assessed after the cataract surgery.
There were 9 emmetropes, and 6 myopes. It could not be ascertained in 4.
All patients were examined with the binocular indirect ophthalmoscope and scleral depressor 6 weeks after the cataract surgery. 59 patients required prophylactic trans conjunctival cryo or photocoagulation. 1 l of the 19 who developed a detachment had normal fundi at this time. The abnormal findings in the remaining 8 are listed in [Table - 2]. Three of the patients did not desire surgery.
The visual acuity of these 16 patients who underwent both cataract extraction and scleral buckling was compared to the visual acuity of 943 eyes in which cataract extraction alone was done. A further comparison was made with another series of 520 eyes in which only a scleral buckling procedure was done. [Table - 3]
| Observations|| |
The incidence of retinal detachment was maximum (3.7%) of the total cataract extraction in the age group 51-60 years-with a male preponderance (15 males and 4 females). The retina detached within 6 months of cataract extraction is 8 eyes, within a year in 4, within 12 years in 5 and after 2 years in 2. 4 cases (4%) in which the extraction was extracapsu.lar developed a detachment in contrast in 14 cases (1.6%) when the lens was delivered intracapsularly. 5 of the 89 (5.6%) patients in whom alpha chymotrypsin was used developed a detachment as compared to 14 of the 898 (1.6%) in whom it was not used. Retinal detachment occurred in 1 patient out of the 42 eyes in which vitreous was lost (2.4%), and in 18 out of the 945 (1.1%) where there was no loss of vitreous. Fresh breaks were responsible for the detachment which occurred in two patients 18 months after prophylactic cryo or Photocoagulation therapy.
Details pertaining to the nature of the detachment, the nature, number, quadrantic distribution and location of the retinal breaks are listed in [Table - 4],[Table - 5],[Table - 6]. 7 cases presented with only a single retinal break. There were no holes in 3 and the rest had a varying number of holes. There were more nasally situated breaks than temporal ones.
6/18 or better vision after the two procedures was obtained in 52.7% in contrast to 28.3% after retinal detachment surgery alone and 81.1% after cataract extraction alone. There was a recurrence of detachment in 2 (1.05%) who had both procedures. In one, the retina was totally detached on the 1st post operative day and in another, the detached 18 months later following a fresh break and sub retinal fibrosis. Both were inoperable. This figure is in contrast to the 11.2% who developed a recurrence after retinal surgery alone.
| Discussion|| |
Though the majority of patients who underwent cataract extraction belonged to the 61-70 years age group, the incidence of retinal detachment was greatest in the 51-60 years age group (3.7%) followed by 3.2% of the 41 - 50 years group. It is significant that only 0.6% above the age of 70 years developed a retinal detachment. The facts that aphakic retinal detachments are common in males, and occuring most commonly within a year after cataract extraction with a higher incidence in those in whom alpha chymotrypsin was used and in those in whom vitreous was lost have been remarked by previous authors.
The vigorous washing of the anterior chamber probably has a role to play in the greater incidence of retinal detachment in patients who had an extracapsular extraction. The more frequent occurrence of nasal breaks is probably due to the fact that there is a greater crowding of structures as the nasal ora where the zonules are attached.
Prophylactic therapy had prevented a retinal detachment in 49 cases (96.1%). This underscores the importance of careful examination of the fundus with the binocular indirect ophthalmoscope and scleral depressor after cataract surgery and meticulous follow up.
The final visual acuity of 6/18 or better in 57.8% of the patients was considered to be good in spite of the fact that aphakic retinal detachments are considered to have a relatively poorer prognosis. The results are better when compared to those who had retinal detachment surgery alone and compares well with those who had cataract extraction alone. Good results are possible if all patients who undergo cataract surgery are examined periodically and thoroughly, if prophylactic treatment is given at the appropriate time and detachments treated early.
| Summary|| |
19 cases which developed a retinal detachment cut of 987 who underwent cataract extraction have been analysed- with regard to the types of cataracts, their mode of extraction and the time lag between cataract extraction and detection of retinal detachment. The various characteristics of the retinal breaks and the final visual acuity after successful retinal detachment surgery have been mentioned and the need for careful retinal examination and prophylactic therapy in patients who had undergone cataract extraction stressed.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]