A Result of Pneumatic Retinopexy for Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical effectiveness of pneumatic retinopexy as a treatment method for pseudophakic retinal detachment. METHODS: A retrospective chart review was conducted of medical records of 38 patients who underwent pneumatic retinopexy using SF6 gas from January 2003 to December 2011 and who were observed during a follow-up period longer than 6 months. Primary and final success rates and final visual acuity were analyzed. Primary success was defined as retinal attachment at the last visit without additional surgery. Final success was defined as retinal reattachment at the last visit regardless of additional surgery. RESULTS: The mean patient age was 58.47 ± 17.00 years. All retinal tears were located in the upper retina (from 8 to 4 o'clock). Preoperative mean visual acuity was 1.17 ± 1.00 log MAR, and postoperative mean visual acuity was 0.42 ± 0.48 log MAR. The primary success rate was 61%, and patients with re-detached retina underwent repeat pneumatic retinopexy or other surgery such as scleral buckling or pars plana vitrectomy. At the final visit, all of the patients demonstrated successful results. CONCLUSIONS: Pneumatic retinopexy does not result in strabismus or refractive error, and the final success rate was 66% in our study. Therefore, pneumatic retinopexy can be considered as an effective management technique for some pseudophakic retinal detachment patients.

Clinical Results between Scleral Buckling and Vitrectomy in Pseudophakic Retinal Detachment with Intact Posterior Capsule

PURPOSE: To compare the clinical outcomes between scleral buckling and vitrectomy in the primary management of pseudophakic retinal detachment with an intact posterior capsule. METHODS: The medical records of 63 eyes that underwent scleral buckling (36 eyes) or vitrectomy (27 eyes) as a primary operation of uncomplicated pseudophakic retinal detachment with intact posterior capsules with a follow-up of more than one year were retrospectively reviewed from 2000 to 2005. We compared the clinical outcomes using anatomical and functional success rates at postoperative one year. Anatomical success was defined by a reattachment rate and functional success was measured by a change of more than 0.3 logMAR. RESULTS: Anatomical success rates were 86% in the scleral buckling and 82% in the vitrectomy, respectively (p=0.837). Functional success rates were 81% in the scleral buckling and 70% in the vitrectomy, respectively (p=0.065). There were no significant differences of anatomical and functional success rates according to each surgical procedure. CONCLUSIONS: Either scleral buckling or vitrectomy may be chosen as a primary operation in the management of pseudophakic retinal detachment with intact posterior capsule.

Onset of Retinal Detachment in Eyes with Phacoemulsification and Posterior Chamber Lens Implantaton

PURPOSE: To evaluate the onset of retinal detachment (RD) in eyes with phacoemulsification and post chamber lens (PE & PCL) implantation. METHODS: We retrospectively analyzed 3023 eyes that had undergone clear cornea incision and PE and PCL implantation and 116 eyes that had undergone scleral incision and PE and PCL implantation. They had been operated from January 1995 to December 2000 by one surgeon and followed up for 4 years or more. RESULTS: Eighteen eyes (0.57%) of the 3139 eyes developed pseudophakic RD within a mean period of 663 days. In the scleral incision group, there were 4 cases of pseudophakic RD (3.4%) of 116 eyes developed in a mean period of 185.2 days. In the clear cornea group, there were 14 pseudophakic RD eyes (0.46%) of the 3023 eyes and the mean period was 799 days. Of these, 3 eyes made up the intraoperative complication group with a mean period 205.6 days. But in the group of cases with no intraoperative complications, the mean period was 962 days. CONCLUSIONS: In high myopic eyes, retinal detachment developed in the earlier postoperative period and at a higher rate than those of non-high myopic eyes after PE and PCL implantation.

Clinical Characteristics and Surgical Outcomes of Pseudophakic and Aphakic Retinal Detachments

We retrospectively evaluated the clinical characteristics and surgical outcomes of 20 pseudophakic retinal detachment (RD) patients (20 eyes) and 17 aphakic RD patients (17 eyes). Males were predominated in both groups. The time interval between cataract extraction and RD was 31 months on average in the pseudophakic group, 32 months with intact posterior capsule and 27 months with ruptured posterior capsule, and 148 months in the aphakic group. In 50% of cases with ruptured posterior capsule in the pseudophakic group, RD occurred within 1 year. The anatomic success rate was 95% in the pseudophakic group and 88% in the aphakic group. The most common cause of failure was the development of proliferative vitreoretinopathy. Visual acuities more than 20/40 after RD surgery were found in 13 pseudophakic (65%) and 6 aphakic (36%) eyes. Aphakic patients were more inclined to have silent RD than pseudophakic patients because of their poor visual acuity. Post-operative follow-up is required especially for the first 1 year in cases of damaged posterior capsule due to the high incidence of RD during this period.

Clinical Evaluation of Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical characteristics of pseudophakic retinal detachment(RD) as RD is the most common sight-threatening complication after cataract surgery. METHODS: We analysed retrospectively the clinical characteristics of 22 pseudophakic RD patiens(23 eyes) which had been operated from January 1993 to December 1997 and followed for 6 months or longer at the Gyeongsang National University Hospital. RESULTS: The average age of the patients was sixty-three and male predominated 19 eyes(82.6%). According as types of IOL implantation included 14 eyes with posterior chamber IOL, 7 eyes with sclera-fixated IOL, 2 eyes with anterior chamber IOL, and 16 eyes(70%) occurred the posterior casule rupture. The interval between IOL implantation and the development of RD was 9.6 months on average and 78% of eyes developed RD within 1 year. In eyes with sclera-fixated IOL, the interval was shorter than others, In cases with ruptured posterior capsule, RD occurred earlier than those with intact posterior capsule. Retinal breaks were principally located in the upper quadrants in 12 eyes(63%) and horseshoe tear was most commmonly encountered. RD involving 3 or more quadrants was observed in 12 eyes(51%) of patients, and macular detachment in 18 eyes(78%). Anatomic success achieved in 83%. The most common cause of the failure was the development of proliferative vitreoretinopathy. Visual results in eyes with ultimate anatomic success of RD repair improved 0.5 or more in 80% if the macula was not involved and in 14.2% if the macula was involved. CONCLUSION: We thought that thorough fundus examination is neccessary during the follow-up of pseudophakic eye with posterior capsule rupture and sclera-fixated IOL after cataract surgery.

Comparision of Clinical Findings between Phakic Retinal and Pseudophakic Retinal Detachment

We reviewed our medical records of primary retnal detachment(239 patients, 243 eyes) to compare the clincal findings of phakic retinal detachment(206 eyes) and pseudophakic retinal detachment(37 eyes). Pseudophakic retinal detachment was more common in male(73.0%) than in female(27.0%) and occurred more frequently in aged 60 years or more than phakic retinal detachment(10.4%)(P<0.001). Associated ocular finding such as high myopia(35.0%), peripheral retinal degeneration(23.3%0, retinal tear in fellow eye(5.8%) were more commonly seen in phakic retinal retinal detachment. Rupture of posterior capsule(40.5%), high myopia(18.9%), small pupil(13.5%) were associate with pseudophakic retinal detachment. In pseudophakic retinal detachment, more than 3 quadrant retinal detachment(73.0%) and macular involvement(78.4%) were more common than in phakic retinal detachment(P<0.01), but atropic hole(29.7%), or 2 or more retinal break(10.8%) were less common than in phakic retinal detachment(P<0.01) where the success rate of first operation(59.5%) and the overall success rate(81.1%) were lower in paeudophakic retinal detachment than phakic retinal detachment. The degree of visual recovery was nearly equal between two.

Pseudophakic/Aphakic Retinal Detachment Surgery Using Scleral Depression Technique

In aphakic/pseudophakic retinal detachments, difficulty in visualizing the peripheral retina and perhaps higher incidence of proliferative vitreoretinopathy result in lower success rate than phakic retinal detachment. We performed pars plana vitrectomy on 20 eyes with aphakic/pseudophakic retinal detachment. In most cases, we combined scleral bucking or encircling procedure. Using scleral depression technique, we found retinal breaks, dissected the vitreous base meticulously, and removed the vitreoretinal tractions. Intraoperatively, we were able to find retinal breaks in 12 eyes in which retinal breaks were not identified preoperatively, and identify additional retinal breaks in 3 of the remaining 8 eyes. We obtained anatomical success in all eyes and favorable visual acuity of better than 0.025 in 16 eyes (80%). These results suggest that finding all retinal breaks and removing vitreoretinal tractions are directly related to the improvernent of the surgical results.

Characteristics of Retinal Detachment in Pseudophakic Eyes

To evauate the clinical characteristics of pseudophakic retinal detachments, 20 eyes were reviewed retrospectively. We identified the following characteristics of pseudophakic retinal detachment ; age in period of 40 (35%) and 60(30%), male(65%), rupture of posterior capsule (intraoperative and YAG laser capsulotomy)(50%). 15(75%) of the 20 pseduophakic retinal detachment eyes occured within 24months from the time of cataract surgery. Within 6 months after cataract surgery, the incidence of retinal detachment after posterior capsule rupture was higher than after uncomplicated cataract surgery, but there was no statistical significance. Retinal breaks were not detected in 7 eyes(35%). Retinal breaks were principally located in the upper quadrant in 6 eyes, horsehoe tear and atropic hole were most commonly encountered. More than 3 quadrant retinal detachment was observed in 80% of patients at the time of presentation and macular detachment, in 75%, Anatomic success rates were 85%. All of the failures were due to proliferative vitreoretinopathy.