Year : 1984 | Volume
: 32 | Issue : 4 | Page : 217--219
A comparative study of retinal breaks in phakic and aphakic retinal detachment
OP Ahuja, Manoj Shukla, Praveen Kumar
AMU Institute of Ophthalmology Aligarh, India
Institute of Ophthalmology Aligarh Muslim University Aligarh
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Ahuja O P, Shukla M, Kumar P. A comparative study of retinal breaks in phakic and aphakic retinal detachment.Indian J Ophthalmol 1984;32:217-219
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Ahuja O P, Shukla M, Kumar P. A comparative study of retinal breaks in phakic and aphakic retinal detachment. Indian J Ophthalmol [serial online] 1984 [cited 2023 Jun 1 ];32:217-219
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1984/32/4/217/27392
The aim of this study is to bring about a comparative analysis of retinal breaks- and their meridional distribution in retinal detachment of aphakic eyes as compared with phakic eyes.
MATERIALS AND METHODS
The present study is a retrospective analysis of 280 eyes of 271 consecutive cases of rhegmatogenous retinal detachmnt seen at our center during the years 1978-1981. 198 (70.71%) eyes were phakic while the remain�ing 82 (29.29%) eyes were aphakic. These eyes were examined by a painstaking indentation indirect ophthalmoscopy which was sup�plemented by posterior segment biomicros�copy with the help of a Goldmann's 3-mirror contact lens. A special attention was paid to study the morphological changes in the vit�reous during three mirror examination.
A total number of 445 retinal breaks of dif�ferent types were observed in the affected eyes. Out of these, 344 retinal breaks were seen in 178 eyes with phakic retinal detachment with an average of 1.93 break per eye while the remaining 101 retinal breaks were present in 59 aphakic eyes with an everage of 1.71 break per eye. No retinal break was seen in 20 (10.10%) phakic eyes and 23 (28.95%) aphakic eyes.
Horse shoe tears (53.46%) were the com�monest type of retinal breaks seen in aphakic retinal detachment while round holes (48.54%) were the commonest variety in phakic detachment [Table 1]. Round holes were either seen alone or more commonly in the substance of individual islands of lattice degeneration which was the causative factor for retinal break formation and retinal detachment in 39 (19.70%) phakic eyes and 9 (10.98%) aphakic eyes.
Equatorial region of peripheral retina was the commonest site of the occurance of retinal breaks in both types of retinal detachment followed by pre-equatorial and post�equatorial regions. Although majority of retinal breaks were located in the supero�temporal quadrant of peripheral retina in both phakic and aphakic eyes [Table 2], the incidence of retinal breaks in aphakic eyes was significantly higher in infero-nasal quad�rant as compared with phakic eyes (p=0001).
Retinal breaks present some distinct features in phakic and aphakic retinal detachment, In the former, localisation of retinal break is usually not difficult while in the aphakic eyes, it is often a serious problem on account of factors like small pupil, pos�terior sypechia, after cataract and vitreous haze. The failure rate in detecting the retinal break in aphakic retinal detachment has been described as 15%, 16%, and 18.8%. In our study it was 28.05% and this was primarily on account of poor visibility of the retina in such eyes.
A frequent occurence of horse shoe tears in aphakic retinal detachment is probably related to the distrubances of vitreous base following vitreous loss during cataract extrac�tion. An increased incidence of horse shoe tears in aphakic retinal detachment has been reported by other workers,. Anatomically nasal portion of suspensory ligament of lens has a shorter course form equator of lens to its insertion at ora serrata. This would indirectly result in a more direct pull on the nasal peripheral retina after lens extraction. It would thus be reasonable to understand that nasal portion of retina in aphakic eyes is also at greater risk in developing retinal breaks specially in the infero-nasal quadrant as was seen in this study. A relatively common occurrence of retinal breaks in the nasal hemretina of aphakic eyes has also been des�cribed by other workers ,,,,, It is therefore, essential to screen the nasal hemiretina of aphakic eyes specially the infero-nasal quad�rant besides a customary examination of tem�poral retina to locate retinal defects which otherwise may be missed. Such an approach may be of great help i n solving a difficult pro�blem of locating aphakic retinal breaks and consequently would have a bearing on the surgical prognosis of such cases.
The retrospective study of 280 eyes having rhegmatogenous retinal detachment, revealed certain significant differences bet�ween retinal breaks in phakic and aphakic retinal detachment. While horse shoe tears are the commonest type seen in the aphakic eyes, round holes, either isolated or more commonly with lattice degeneration are pre�dominantly present in phakic eyes. Infero�nasal quadrant of retina in aphakic eyes deserves a meticulous examination in order to locate retinal defects. A proper examination of this area may help in reducing failure rate in localising retinal breaks in aphakic eyes.
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