Year : 1981 | Volume
: 29 | Issue : 4 | Page : 455--458
Cataract extraction after retinal detachment surgery
Sita Tatapudi, Mary Nalini Abraham, SS Badrinath
Medical Research Foundation, Madras, India
Medical Research Foundation, 18 College Road, Madras 600 006
|How to cite this article:|
Tatapudi S, Abraham MN, Badrinath S S. Cataract extraction after retinal detachment surgery.Indian J Ophthalmol 1981;29:455-458
|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 2021 Jan 19 ];29:455-458
Available from: https://www.ijo.in/text.asp?1981/29/4/455/30953
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
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.
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.
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.
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.