RETINAL-DETACHMENT AFTER CATARACT-SURGERY

Background: A study of the characteristics and the results obtained in 99 consecutive eyes operated on for rhegmatogenous retinal detachment associated with aphakia or pseudophakia in order to find the predicti ve factors of poor anatomical and functional results. Methods: The aut hors retrospectively reviewed the files of 99 consecutive cases of aph akic and pseudophakic retinal detachment operated on by the same surge on between January 1992 through July 1993 with a minimum follow-up of 6 months. Multivariate and chi square analysis were carried out. Resul ts: Of the pseudophakic eyes, 25 had an anterior chamber lens and 48 h ad a posterior chamber lens. The posterior capsule was disrupted using a Yag laser in 58% of those with an posterior chamber lens but only 1 4% of them developed detachment within 6 months. The rate of vitreous loss was 27% with 5% in case of intracapsular extraction, 31% in case of extracapsular extraction and 54% in case of phacoemulsification. PV R was present in 30% of the patients and 51% of detachments occurred m ore than 24 months as a mean after cataract surgery. The overall anato mic reattachment rate was 88% with no significant difference between t he aphakic and the pseudophakic patients, either with an anterior cham ber of posterior chamber lens. Visual results were significantly worse in the anterior chamber lens group and in the aphakic eyes (P < 0.02) . Negative prognostic indicators for reattachment included poor preope rative vision, extension of the retinal detachment to the macula (P < 0.05) and grades B, C or D proliferative vitreoretinopathy (P < 0.01). In addition to the above factors, eyes with vitreous loss, anterior c hamber lens, aphakia and a larger extent of the retinal detachment had a poor visual outcome. Conclusion: Most aphakic or pseudophakic retin al detachment can now be reattached with either scleral or vitreo reti nal surgery. The main difficulties are the localisation of the breaks and the treatment of PVR. Indirect ophthalmoscopy associated with vitr ectomy does well in cases of an opacified posterior capsule. In cases of severe PVR long term internal tamponade either with C3F8 or silicon e oil improves anatomical results but the functional results remain in ferior.