retinal detachment with intraocular lenses Dennis D. Shepard, M.D. Santa Maria, California
Of 740 patients who underwent intracapsular cataract extraction with intraocular lens (IOL) implantation by the author, 18 (2.43%) experienced retinal detachment. The incidence of retinal detachment in uncomplicated, non-implant cataract extraction is 2% to 3%.1 Analysis of the data reveals the series covered 6.25 years (75 months). The right eye was involved 10 times, the left eye 8. There were 13 males and 5 females (72% males). At the time of their cataract surgery, the youngest was 45, the oldest 85. The average age was 63; the median age was 65. The median duration between cataract surgery and retinal detachment was 10.8 months. However, the shortest interval was 5 weeks, the longest was 39 months (2 patients). Jungschaffer2 has stated that the median duration in his series was 5 Y2 months. A possible explanation for this difference was that he was not seeing all the patients in a series with deta~hments, only those referred to him for surgical repair. Of the 18 patients, 15 (83%) had retinal detachment repair with an encircling element. One (6%) required a second (or repeat) operation. Of the remaining three, one (6%) was inoperable and two (11 %) refused detachment surgery - one said she was "too old", the other said the detachment was the "will of God. " Vitreous loss at the time of cataract surgery was documented in 6 patients (33%). Vitreous loss occurred twice as often in males. A severe fall was noted in 3 cases (17%) preceding the detachment. Two patients (11%) had "office repositioning" of their subluxated IOL prior to their detachment. Isolated situations occurring before detachment were as follows: one patient used Humorsol 0.25% drops (demecarium bromide); one had glaucoma pre-operatively; one required alpha-chymotrypsin for cataract extraction; one had a severe hyphema postoperatively; one patient, a farmer, was lifting 100 lb. (45 Kg) sacks of feed, and one patient suffered a wound dehiscence 3Y2 weeks post-operatively which
Presented at the American Intra-Ocular Implant Society Symposium, Century City, CA, Mar. 1978. Reprint requests to Dennis D. Shepard, M.D., FACS, 1414 S. Miller Street, Santa Maria, California 93454.
healed without repair ... detachment occurred 38 months later. Only 6 (33%) of the 18 achieved useful postdetachment vision of 20/50 or better (6/15 or better). Their average age was 57. One had intractable vertical diplopia residual from the detachment surgery. Categorizing the IOLs3 used, there were 8 Medallions with Supramid loops, 6 Binkhorst-Federovs with Supramid loops, 2 Platinas with Supramid loops and a metal stave, one Medallion-style with metal loops and one Platina-style with metal loops. Of the 6 detachment repairs resulting in industrially-useful vision, all 6 occurred with Supramidlooped lenses, viz., 3 Medallions and 3 BinkhorstFederovs. Summary Of 740 patients undergoing intracapsular cataract extraction with intraocular lens implantation by the same surgeon, 18 (2.43) experienced retinal detachment. Analysis of the data of these 18 patients reveals: the series covered 6.25 years (75 months). there were 13 males and 5 females (72% males). their average age at the time of cataract surgery was 63. the median duration between cataract surgery and retinal detachment was 11 months. The shortest interval was 5 weeks, the longest was 39 months. a predisposing fall was documented in 17%. 33% suffered vitreous loss at the time of cataract extraction. of the 18 patients, 15 (83%) underwent retinopexy; of the remaining 3, one eye (6%) was not repairable and 2 patients (11%) refused detachment surgery. only 6 (33%) of the 18 achieved useful post-detachment vision.
Bibliography 1. McDonald, P.R.: Complications of cataract surgery, in Fasanella, R.M. (ed): Complications in Eye Surgery. Philadelphia, W.B. Saunders Co., 1965, p. 233. 2. Jungschaffer, 0.: Aphakic retinal detachments with pseudophakia. Presented at the Contact Lens Association of Ophthalmologists meeting, Las Vegas, Nevada, Jan. 1978. 3. Shepard, D.D. (ed): The Intraocular Lens Manual. Santa Maria, CA, Shepard, 1977, p. 28-42.
AMERICAN INTRA-OCULAR IMPLANT SOC. JOURNAL :- VOL. IV, APRIL 1978. 55
Of 740 patients who underwent intracapsular cataract extraction with intraocular lens (IOL) implantation by the author, 18 (2.43%) experienced retinal detachment. The incidence of retinal detachment in uncomplicated, non-implant cataract extraction is 2% to 3%.1 Analysis of the data reveals the series covered 6.25 years (75 months). The right eye was involved 10 times, the left eye 8. There were 13 males and 5 females (72% males). At the time of their cataract surgery, the youngest was 45, the oldest 85. The average age was 63; the median age was 65. The median duration between cataract surgery and retinal detachment was 10.8 months. However, the shortest interval was 5 weeks, the longest was 39 months (2 patients). Jungschaffer2 has stated that the median duration in his series was 5 Y2 months. A possible explanation for this difference was that he was not seeing all the patients in a series with deta~hments, only those referred to him for surgical repair. Of the 18 patients, 15 (83%) had retinal detachment repair with an encircling element. One (6%) required a second (or repeat) operation. Of the remaining three, one (6%) was inoperable and two (11 %) refused detachment surgery - one said she was "too old", the other said the detachment was the "will of God. " Vitreous loss at the time of cataract surgery was documented in 6 patients (33%). Vitreous loss occurred twice as often in males. A severe fall was noted in 3 cases (17%) preceding the detachment. Two patients (11%) had "office repositioning" of their subluxated IOL prior to their detachment. Isolated situations occurring before detachment were as follows: one patient used Humorsol 0.25% drops (demecarium bromide); one had glaucoma pre-operatively; one required alpha-chymotrypsin for cataract extraction; one had a severe hyphema postoperatively; one patient, a farmer, was lifting 100 lb. (45 Kg) sacks of feed, and one patient suffered a wound dehiscence 3Y2 weeks post-operatively which
Presented at the American Intra-Ocular Implant Society Symposium, Century City, CA, Mar. 1978. Reprint requests to Dennis D. Shepard, M.D., FACS, 1414 S. Miller Street, Santa Maria, California 93454.
healed without repair ... detachment occurred 38 months later. Only 6 (33%) of the 18 achieved useful postdetachment vision of 20/50 or better (6/15 or better). Their average age was 57. One had intractable vertical diplopia residual from the detachment surgery. Categorizing the IOLs3 used, there were 8 Medallions with Supramid loops, 6 Binkhorst-Federovs with Supramid loops, 2 Platinas with Supramid loops and a metal stave, one Medallion-style with metal loops and one Platina-style with metal loops. Of the 6 detachment repairs resulting in industrially-useful vision, all 6 occurred with Supramidlooped lenses, viz., 3 Medallions and 3 BinkhorstFederovs. Summary Of 740 patients undergoing intracapsular cataract extraction with intraocular lens implantation by the same surgeon, 18 (2.43) experienced retinal detachment. Analysis of the data of these 18 patients reveals: the series covered 6.25 years (75 months). there were 13 males and 5 females (72% males). their average age at the time of cataract surgery was 63. the median duration between cataract surgery and retinal detachment was 11 months. The shortest interval was 5 weeks, the longest was 39 months. a predisposing fall was documented in 17%. 33% suffered vitreous loss at the time of cataract extraction. of the 18 patients, 15 (83%) underwent retinopexy; of the remaining 3, one eye (6%) was not repairable and 2 patients (11%) refused detachment surgery. only 6 (33%) of the 18 achieved useful post-detachment vision.
Bibliography 1. McDonald, P.R.: Complications of cataract surgery, in Fasanella, R.M. (ed): Complications in Eye Surgery. Philadelphia, W.B. Saunders Co., 1965, p. 233. 2. Jungschaffer, 0.: Aphakic retinal detachments with pseudophakia. Presented at the Contact Lens Association of Ophthalmologists meeting, Las Vegas, Nevada, Jan. 1978. 3. Shepard, D.D. (ed): The Intraocular Lens Manual. Santa Maria, CA, Shepard, 1977, p. 28-42.
AMERICAN INTRA-OCULAR IMPLANT SOC. JOURNAL :- VOL. IV, APRIL 1978. 55
