Indian Journal of Ophthalmology

ARTICLES
Year
: 1983  |  Volume : 31  |  Issue : 7  |  Page : 1060--1063

Retinal detachments in phakics and aphakics-a clinical study


B Rajendran, B Pradeep, B Sitaramanjaneyulu 
 Vijaya Hospital Madras, India

Correspondence Address:
B Rajendran
Vijaya Hospital Madras
India




How to cite this article:
Rajendran B, Pradeep B, Sitaramanjaneyulu B. Retinal detachments in phakics and aphakics-a clinical study.Indian J Ophthalmol 1983;31:1060-1063


How to cite this URL:
Rajendran B, Pradeep B, Sitaramanjaneyulu B. Retinal detachments in phakics and aphakics-a clinical study. Indian J Ophthalmol [serial online] 1983 [cited 2021 Sep 19 ];31:1060-1063
Available from: https://www.ijo.in/text.asp?1983/31/7/1060/29747


Full Text

The characteristic differences, if any, bet­ween Phakic Retinal Detachments (PRD) and Aphakic Retinal Detachments (ARD) have long been a subject of interest. The pur­pose of this study was to analyse the clinical similarities and differences in these groups in relation to the eypes of detachments, presen­tation and surgical procedures adopted in the two groups.

 MATERIALS AND METHODS



For the purpose of this study we looked at 50 consecutive Retinal Detachments (in 45 patients) in our series with a minimum follow up of 1 year. No attempt at case selection was made.

In the 50 cases thus analyed we found that 35 cases were phakic and 15 were aphakic.

 OBSERVATIONS



Patients with ARD were mostly in the older age group and the majority were in the age group of 60-70 years (53.3%) [Table 1] The strong influence of old age on ARD was indicated by the fact that 66.6% of the cases in the series occurred above the age of 60 years as compared to only 6.6% of the PRD occurring above the age of 60 years.

Males were significantly more affected in both groups [Table 2]. The higher proportion of males in the ARD population confirms that retinal detacments affects males preferen. tially, at least in some special groups. Since senile cataracts affects both sexes equally, it is retinal detachment itself which affects males preferencially in aphakic patients.

The right eye was predominantly afected in PRD [Table 3] but in the ARD population it was almost equally distributed.

Nearly 50% of the cases both phakic and aphakic were seen by us within one month of the onset of symptoms [Table 4].8 phakic eyes were found to have localised Retinal De­tachments on routine examination and were subjected to surgery. No such localised detachments were seen in the ARD group.

Contrary to popular belief, only 3 out of the 15 aphakics presented with detachments within one year after Cataract Surgery [Table 5].

6 cases developed detachments more than 5 years after Cataract Surgery including one case who developed ARD 15 years after needl­ing and another 10 years after routine cataract extraction.

Nearly 75% of the ARDs involved were total or near total detachment-suggestive of the fact that ARDs tend to spread faster than PRDs.

In 27% of the ARD no holes were seen [Table 7] as compared to only 6% in the Phakic group.

In 75% of the phakics the holes were in one or two quardrants while this was so in only 53% of the aphakic group. No giant tear or dialysis was found in the ARD population.

All cases of detachment whether PRD or ARD underwent similar surgical procedures. SRF was drained where indicated, Cryo was applied for all cases and Silicone sponge explants done in all cases.

Circumferential buckles were produced in the majority of cases in both categories. In 2 cases of PRD a radial buckle alone was made.

While in 2 cases of PRD and one case of ARD a combined radial and circumferential buckle was made.

The use of 360° buckles was significantly more in aphakics than in the phakics but it would be wrong to assume that encirclage is the procedure of choice in ARD.

2 cases in the ARD group had buckles less than 360° and in one of them the buckle was less than 180°.

SRF drainage was done in almost all cases of ARD since they tended to have high balloonous detachments involving larger areas of the retina.

In the PRD group we have drained and not drained in almost equal proportions the deciding factors being the amount of SRF present and the height of the detachment.

Anotomical reapposition was obtained in 91% of the phakic group and 80% of the aphakic group.

MVR has been the cause of failure in all the 3 cases of ARD which redetached. In the 3 cases that failed in the phakic group 2 failed to attach due to a dense traction band in one case and a giant tear in another. The third was again a victim of MVR.

In this series only 35% of the PRD and 20% of the ARD had a normal other eye.

Prophylactic measures if any must be taken at this stage for predetachment pathology in the other eye.

We have inferred from the above study that

1. Patients with ARD tend to seek help earlier

2. Localised Retinal Detachment in asy­mptomatic patients were detected in the PRD and not in the ARD group.

3. Contrary to popular belief ARD can occur several years after cataract surgery.

4. APHARKC RETINAL DETACH­MENT tend to be total or near total in a majority of cases

5. Incidence of `no holes' is much more in ARD

6. Circumferential buckles were used in equal proportion in ARD and PRD

7. 360° buckles were significantly more in ARD

8. Majority of ARD required drainage

9. Rate of reattachment was marginally more in PRD

10. Incidence of MVR is significantly more in ARD and

11. Tat only 33% of PRD and 20% ARD had a normal other eye.[1]

References

1Ashrafzadch 1973, Arch Ophthalmol. 89:476.