March 2010

 

CATARACT /IOL

 

Retinal hole incidence


by Matt Young EyeWorld Contributing Editor

   
Retinal detachment Source: Henry Muller, M.D.

Although studies have shown that myopia is significantly linked with retinal detachment (RD) after cataract surgery, a new report has revealed a higher degree of detail about who is most likely at risk. Research points to males with high degrees of myopia, and not only right after cataract surgery but over the long term. “Our findings support the need for a full preoperative explanation and continued education of the long-term risk of RD in high-risk patients, especially myopic men,” reported lead study author Shwu-Jiuan Sheu, M.D., chair, Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. The study appeared in the January issue of the American Journal of Ophthalmology.

Revealing statistics

Dr. Sheu analyzed 9,388 cases involving cataract surgery in Taiwan, among whom 5,235 were female and 4,153 were male. The cumulative eight-year retinal detachment rate was 2.31%, which the researchers suggested was within the norm as determined by previous research. Those factors impacting RD risk after cataract surgery included being male, being younger than 50 years old, axial length, a history of retinal detachment in the fellow eye, and phacoemulsification. “The greater the AL, the higher the risk of pseudophakic RD was,” Dr. Sheu reported. “Patients with ALs of more than 26 mm tend to have a late wave of increased RD after 4 years.”

Dr. Sheu suggested the so-called link between phacoemulsification and RD has some—but not total—support in previous literature. “Phacoemulsification was reported to carry either similar or an even lower risk than ECCE [extracapsular cataract extraction],” Dr. Sheu noted. “[However, other researchers] found pseudophakic RD to be higher after phacoemulsification in the years soon after its introduction as a new surgical technique. The discrepancy of RD risk of the patients collected in the first year and second year in our study was compatible with their findings. We speculate that this may be the result of underreported complications during phacoemulsification during the surgeons’ learning curve in the first year. With the maturity of surgical skills, phacoemulsification actually would have no difference on the long-term accumulative risk of RD resulting from ECCE.”

The late increase in RD also was noted. “Both moderate and highly myopic males showed a significantly late increase of RD risk 4 years after cataract extraction,” Dr. Sheu reported. “Interestingly, we could not see the same change in the female group, even with high myopia.”

Dr. Sheu discussed why cataract surgery at a younger age and high myopia could also increase one’s risk for RD. “Cataract surgery in highly myopic eyes remains relatively risky, although … the risk for pseudophakic RD in myopic eyes might be the result of the natural risk for RD in myopic eyes,” Dr. Sheu noted. “Because highly myopic patients often receive cataract extraction at an earlier age, their cumulative lifelong risk of RD after cataract extraction is considerable, because the average life span in our country is approximately 80 years.”

Dr. Sheu also suggested trauma could have been a cause of the late-onset RD in males, even if they weren’t reporting the trauma. “The anterior tears that cause most RDs long after cataract extraction were the result of persistent chronic traction on the vitreous base,” Dr. Sheu noted. “We speculate that anomalous posterior vitreous detachment developed years after cataract extraction and caused the late wave of increased risk for pseudophakic RD in our results. However, this speculation could not explain the lack of late increase in females. A possible explanation is that the history of trauma was underreported. Like the incidence of other trauma, men are more prone to have trauma attributable to their lifestyle and work.”

James Maisel, M.D., Hauppauge, N.Y., and Hicksville, N.Y., however, suggested that retinal detachment after cataract surgery has markedly decreased over time. “Twenty-five years ago, in the early 1980s, when cataract surgery changed from intracapsular surgery to extracapsular surgery, there was a marked decrease in the incidence of retinal detachment,” Dr. Maisel said. “A lot of patients used to have retinal detachments after cataract surgery. The problem has almost disappeared.” When vitreous loss occurs during cataract surgery, Dr. Maisel acknowledged that the incidence of retinal detachment “goes up enormously.” If retinal detachment is going to happen, though, he believes it happens fairly soon after cataract surgery. Use of a Nd:YAG laser has also historically increased the incidence of retinal detachment, he said. Myopes have a relatively high risk of retinal detachment, even when cataract surgery isn’t involved, he said. “Physicians should think carefully about operating on nearsighted people,” he said. “Beyond retinal detachment, some nearsighted eyes may have other things going on, such as in retinopathy of prematurity.”

Editors’ note: Dr. Sheu has no financial interests related to this study. Dr. Maisel has no financial interests related to his comments.

Contact information

Maisel: 516-939-6100, zydocmd@yahoo.com
Sheu: sjsheu@vghks.gov.tw

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