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ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 3  |  Page : 199-201

Fundus findings in aphakia


M. & J. Institute of Ophthalmology, Ahmedabad, India

Correspondence Address:
U H Vyas
M. & J. Institute of Ophthalmology, Ahmedabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 6676217

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How to cite this article:
Vyas U H, Khamar B M. Fundus findings in aphakia. Indian J Ophthalmol 1983;31:199-201

How to cite this URL:
Vyas U H, Khamar B M. Fundus findings in aphakia. Indian J Ophthalmol [serial online] 1983 [cited 2024 Mar 29];31:199-201. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1983/31/3/199/29787

Aphakic retinal detachments account for 20% to 50% of all detachments in various reported series. It is also reported that 1% to 3% of aphakics develop retinal detachment in two years of follow up. In India this becomes a major problem as cataract is more prevalent and cataract extraction is carried out at an earlier age.

More than 1,000 consecutive cases of cataract extractions were examined with the help of indirect ophthalmoscope during post­operative period. Slit lamp examination was also performed in these eyes. Some eyes were also examined immediately after operation on table to see effect of surgery.


  Results Top


1. Lattice and Lattice like degenerations which are responsible for retinal detach­ment are seen in only 16 cases i.e. 1.6% only.

2. Full thickness break was seen in only 2 cases (0.2%)

3. Over and above this, in 78 cases (7.8%) haemorrhages of various types were seen in aphakics. They can be classified into five types.

i. Deep retinal tiny - 9 - 11.54% haemorrhages lower periphery - 4 - 5.13 % all around periphery - 5 - 6.41

ii. Superficial retinal haemorrhages in lower periphery around 6 O'Clock along vessels - 17 cases i.e. 21.33%.

iii. Subhyaloid haemorrhages, multiple small haemorrhages in lower periphery - 19 cases i.e. 24.36%.

iv. Large subhyaloid/vitreous haemor­rhages concealing the details of lower peripheral retina - 17 cases i.e. 21.33%.

v. Generalized vitreous haemorrhage, ranging from thin diffuse to dense one. 16 cases i.e. 20.05%.

Association of Haemorrhages

Age group No. of cases % % in normal aphakic



No difference in age group of patients with haemorrhage or without haemorrhage is seen.

II. Experienced and inexperienced Surgeon

Experienced 45 cases 57.7%

Inexperienced 33 cases 42.3%

This suggests that haemorrhage is not because of trauma caused by inexperienced surgeon.

III. Blood Pressure

Normal B.P. 73 cases 93.59%

Hypertension 5 cases 6.41 %

High blood pressure or sclerosis of vessels were not responsible.

IV. Operative Procedure

Cataract extraction

uneventful - 65 cases 83.33%

Vitreous loss - 13 cases 16.67%

1. large suhhyloid

haemorrhage - 10 12.82%

II. Retinal haemor­

rhage - 3 3.84%

In majority of cases i.e. 65, it was uneventful cataract extraction but in 13 it was associated with vitreous loss. Out of these 13 cases in 10 cases it was associated with large subhyaloid haemorrhage. This can be a cause of vitreous loss by increasing the volume of intraocular contents.


  Discussion Top


Lattice degenerations were seen only in 1.6 % of cases. We thought, this to be too low a figure and so checked the aphakic detach­ments. To our surprise the lattice degeneration was found only in 15.5 % of cases of aphakic retinal detachments. This low figure is also consistent with that of Friedman' who found it in 3 % of cases only.

Lower incidence of retinal breaks compared to other series could be because of considering all the cases i.e. preexisting hypermetropes, emetropes and myopes and also because of restricting the study to first 1; month, after cataract extraction.[2],[3] It is demonstrated that tears which make up larger portion are because of traction over the areas of abnormal vitreo­retinal adhesions secondary to the acute posterior vitreous detachment with collapse (2) This occurs comparatively at a later date but usually within 2 years.

Haemorrhages as mentioned are not described in any large series. Few retinal haemorrhages are demonstrated by Friedman 2 and Subhash Sharma' in their study of myopic aphakic eyes. These haemorrhages were not associated with any of the various parameters checked. To know time of the haemorrhages an attempt was made to see the fundus immediately after cataract extraction on table in few cases and then at various time intervals. To our surprise we could see the haemorrhages right on table. This is not reported by anybody who so ever has attempted to see the fundus immediately after cataract extraction .[4] sub The significance of this finding is not known.

This study also highlights the fact that surveillance of aphakic for development of retinal detachment in early post operative period is not that rewarding.


  Summary Top


Fundus was seen with indirect Ophthalmos­cope in detail after cataract extraction in immediate post-operative period (1½ month). It was found that lattice degeneration and breaks are not the major finding contributing to high incidence of aphakic detachments. The haemorrhages in various forms were seen in 7.08 % of cases and can be responsible for higher incidence of M.P.P. in aphakics.

 
  References Top

1.
Friedman, Z.. Neuman, E. and Hyams S., Brit.J. Ophthalmol., 57: 52 1973.  Back to cited text no. 1
    
2.
Friedman, Z., Neuman, E., Brit. J. Ophthalmol.,59: 451, 1975.  Back to cited text no. 2
    
3.
Sharma, Subhash, Mishra, Y.C., Mehlata, Indian J. Ophthalmol., 27: 42, 1979.  Back to cited text no. 3
    
4.
Kirsch Ralph, E., Current concepts in Cataract Surgery, Edi. Jared Emeby & David Paton, C.V. Mosby & Co. St. lou's PP 269-272, 1974.  Back to cited text no. 4
    




 

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