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ARTICLES |
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Year : 1983 | Volume
: 31
| Issue : 3 | Page : 199-201 |
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Fundus findings in aphakia
UH Vyas, BM Khamar
M. & J. Institute of Ophthalmology, Ahmedabad, India
Correspondence Address: U H Vyas M. & J. Institute of Ophthalmology, Ahmedabad India
Source of Support: None, Conflict of Interest: None | Check |
PMID: 6676217
How to cite this article: Vyas U H, Khamar B M. Fundus findings in aphakia. Indian J Ophthalmol 1983;31:199-201 |
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 | | |
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 | | |
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 | | |
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 | | |
1. | Friedman, Z.. Neuman, E. and Hyams S., Brit.J. Ophthalmol., 57: 52 1973. |
2. | Friedman, Z., Neuman, E., Brit. J. Ophthalmol.,59: 451, 1975. |
3. | Sharma, Subhash, Mishra, Y.C., Mehlata, Indian J. Ophthalmol., 27: 42, 1979. |
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. |
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