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   Table of Contents      
ARTICLES
Year : 1981  |  Volume : 29  |  Issue : 4  |  Page : 455-458

Cataract extraction after retinal detachment surgery


Medical Research Foundation, Madras, India

Correspondence Address:
Sita Tatapudi
Medical Research Foundation, 18 College Road, Madras 600 006
India
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Source of Support: None, Conflict of Interest: None


PMID: 7346477

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How to cite this article:
Tatapudi S, Abraham MN, Badrinath S S. Cataract extraction after retinal detachment surgery. Indian J Ophthalmol 1981;29:455-8

How to cite this URL:
Tatapudi S, Abraham MN, Badrinath S S. Cataract extraction after retinal detachment surgery. Indian J Ophthalmol [serial online] 1981 [cited 2019 Dec 9];29:455-8. Available from: http://www.ijo.in/text.asp?1981/29/4/455/30953

Table 6

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Table 6

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Table 5

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Table 5

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Table 4

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Table 4

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Table 3

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Table 3

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Table 2

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Table 2

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Table 1

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Table 1

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There is usually a lot of apprehension in removing a cataract in a patient who has had surgery for retinal detachment in that eye, the main concern being a recurrence of the detach­ment, loss of vitreous and the final visual out­come. Albert L. Ackerman, Morton H. Seelen­freund, H. Mackenzie Freeman, and Charles L. Schepens reported 73 cataract extractions following retinal detachment procedures in which the retina remained reattached in 93 of the cases. Another question that arises is whether any particular factor in the operative procedure of retinal detachment surgery could be the cause of producing a cataract or accele­rate the process in patients who already have lenticular changes.


  Material and methods Top


All 14 patients out of 553 who underwent retinal detachment surgery who required a cataract extraction were studied. The patients age varied from 8 to 73 years [Table - 1]. Only 2 were below 40 years and the rest over 40. The period of follow up was between 6 weeks and 2 years. The lens was extracted atleast 6 months after retinal surgery under local anaes­thesi. A cleat corneal incision was employed and the lens delivered intra-capsularly in 12 patients (86%) using cryo and a muscle-hook employing a careful push and pull technique. Alpha chymotrypsin was employed in all pati­ents under the age of 60 years. Most patients had a broad sector iridectomy and the 2 ex­tracapsular extractions were unplanned. Poste­rior synechiolysis was performed whenever necessary. Vitreous was lost in 2 patients.

11 patients had only a single retinal surgery procedure while 3 were operated upon twice. The incidence of cataracts in diabetics and non-diabetics, belonging to identical age groups has been compared to the incidence of cataracts after retinal detachment surgery [Table - 2].

The lenticular changes prior to detachment surgery was considered moderately severe in 6 and minimal in 2. 2 patients had clear lenses. Inferences on whether any particular step in retinal surgery could have been responsible for the subsequent development of cataract were drawn from the 553 cases which under­went retinal surgery during this period. The probable factors include the extent of chorio­retinal reactions that was created, [Table - 3] the number of perforations to drain sub re­tinal fluid, [Table - 4] intraocular injections, [Table - 5] the type of implant used and para­centesis.

The final visual results were compared to the visual results of 743 patients in whom cataract extraction alone was done during this period. [Table - 6]

The cataracts were removed within a year in 7, within 2 years in 4 and within 3 years in 2. One patient had his cataract removed after 4 years.


  Results Top


The retina remained reattaehed in 9 pati­nts (64%). It re-detached in 5 (36%), of which 2 were due to failure of the detachment surgery itself. In 2 others, fresh holes or tears were responsible for the detachment of which one was reattached after surgery. 1 had massive vitreous retraction.

Nearly 50% of the patients had a visual a­cuity of more than 6/60 after both the pro­cedures. More than 90% in whom cataract ex­traction alone was done had 6/60 or better vision.

Of the 62 patients in whom chorio-retinal reaction was created over an area of 360°, only 1 (1.6%) showed lenticular changes, and only 3 (1.4%) out of 220, where it was limited to 90°. No changes were observed in the 3 lenses where no chorio retinal reaction was made. Paracentesis was done in 189 of the cases-of which only 3 (1.6%) showed lenti­cular changes. 10 cases (3.7%) had lens changes out of 437 when one or two perforations were made to release sub retinal fluid. 34 patients on whom perforations were multiple showed no lens changes. 13 of the 585 patients (2.7%) in whom a silicone implant was used showed lens changes. In 4 of the 14 cases, (4%) either Saline or air was injected into the vitreous cavity.


  Discussion Top


The fact that the retina remained reattached in 9 patients (64%) after extraction of the cataract, and that the final visual acuity was more than 6/60 in more 50% of the patients shows that the final outcome of extracting the acts in these patients is reasonably good. It is difficult to say definitely whether the develop­ment of fresh breaks in 2 and massive vitreous retraction in one were directly related to the extraction of the cataract. Cataracts which can significantly cause visual loss or cataracts which completely obscure fundus detail need to be extracted because they not only give the patient a change of having better visual acuity but also because it enables one to reoperate on the retina if need be. Ultra­sonography and electro retinography can be particularly useful in helping us to choose patients for surgery and anticipating the out­come.

Analysis of [Table - 3],[Table - 4],[Table - 5] shows that none of the steps in retinal detachment surgery are significantly important in inducing cataractous changes or worsening preexisting ones in the lens. However, the incidence of cataract in I non-diabetic patient under 10 years of age is most likely to be related to retinal surgery. Diabetic patients do not show any increased tendency to develop cataracts after detachment surgery as com­pared to the non-diabetic group [Table - 1]. It is most likely that the cataractous changes which occur after retinal surgery are due to the same factors that operate in the causation of a senile cataract.


  Summary Top


The visual results, the state of the retina, the factors that may have operated during the detachment surgery in 14 c, ses which develop­ed a cataract requiring an extraction following retinal detachment surgery have been analysed.



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]



 

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