Retinal Detachment after Cataract Surgery Predisposing Factors Akitoshi Yoshida, MD, Hironobu Ogasawara, MD, Alex E. Jalkh, MD, Reginald]. Sanders, MD, ]. Wallace McMeel, MD, Charles L. Schepens, MD
T
he authors studied the characteristics of 376 eyes of 361 patients with primary retinal detachment (RD) and surgical aphakia (103 eyes) or pseudophakia (273 eyes). Of the pseudophakic eyes, 17 had an iris-fixated intraocular lens (IOL), 111 had an anterior chamber (AC) 10L, and 145 had a posterior chamber (PC) 10L. Of the PC 10L cases, 48 (33%) had undergone VAG capsulotomy, and 46% of them developed RD within 6 months after capsulotomy. The frequency of no breaks found in pseudophakic RD (15%) was significantly higher than in RD with simple aphakia (5%). The most frequent reasons were incomplete fundus view due to a small pupil in the irisfixated (83%) and the AC (44%) groups, and cloudiness of capsular remnants in the PC group (78%). In pseudophakic RD, sizable single tears, located more posteriorly than in RD with simple aphakia, were frequent. The authors speculate that in pseudophakic RD the retinal breaks may resemble those noted in phakic RD . Ophthalmology 1992; 99:453-459
Food and Drug Administration statistics 1 show that 1,174,000 intraocular lenses (IOLs) were implanted in the United States during the 12-month period ending January 1989. Ninety-three percent of these lenses were of the posterior chamber (PC) type while 7% were placed in the anterior chamber (AC). There was a rapid rise in the number of IOLs implanted between 1983 and 1987. Under these circumstances, the treatment of retinal detachment (RD) associated with pseudophakia, in particular the treatment of RD occurring in cases where PC IOLs have been used, is assuming great significance. A number of reports have been published to date on RD in aphakia. 2- 6 More recently, articles have appeared on RD in pseudophakia. 7- l7 The largest number ofpseudophakic RDs has been reported by Cousins et al 17 in 600 eyes
Originally received: April 30, 1991. Revision accepted: September 30, 1991. From the Eye Research Institute, and Retina Associates, Boston. Dr. Yoshida was on leave from the Department of Ophthalmology, Asahikawa Medical College, Japan. Reprint requests to Alex E. Jalkh. MD, Eye Research Institute of Retina Foundation, 20 Staniford St, Boston, MA 02114.
undergoing RD repair between 1974 and 1984. In this report, there were only 75 cases (12.5%) with PC IOLs, and 525 (87.5%) with either iris-fixated IOLs or AC IOLs. Because of this difference, the data provided by these authors are not applicable to the current situation where PC IOLs are mostly used. The current report presents a comparison of the characteristics of aphakic and pseudophakic RD observed in the same institution over the same period of time. Our study includes the largest number of cases ofpseudophakic RD in which PC IOLs were used.
Materials and Methods The Retina Associates allowed us to review the consecutive records of 376 eyes with primary aphakic or pseudophakic RD operated on between May 1982 and April 1989. All records contained the ocular history of the patient, visual acuity, anterior segment findings, and detailed fundus drawings. Cases of penetrating ocular trauma or diabetic retinopathy and those where the primary retina operation was performed elsewhere were excluded. In some instances, one or two details of information were
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not available, such as the duration of presenting symptoms or the interval between a Y AG capsulotomy and the occurrence of RD. Those cases were included in the analysis. Information was recorded on the cataract extraction, including the method of extraction, type of IOL inserted, and surgical complications, if any. The status of the posterior capsule, intact or not, a history of Y AG capsulotomy, and the interval between the capsulotomy and RD were carefully noted. This information was obtained, for each case, by a letter from the referring ophthalmologist. It was confirmed by precise preoperative biomicroscopic examination. The presence and duration of sUbjective symptoms were recorded, such as floaters, flashes, decreased vision, and visual field defects. Best corrected visual acuity was obtained at the initial visit. The presence or absence of macular detachment, vitreous hemorrhage, and vitreous gel herniation into the anterior chamber was noted. When present, a vitreous hemorrhage was examined by indirect ophthalmoscopy and recorded on a large fundus drawing. It was defined as hemorrhage found in the vitreous cavity that obstructed the view of major retinal vessels at least on part of their course. Preoperative uveitis was recorded according to the inflammatory reaction present in the AC. Detailed binocular indirect ophthalmoscopy was performed in every case to search for retinal breaks. The small pupil, binocular indirect ophthalmoscope was extremely useful in detecting retinal breaks when the pupil was small or partially obstructed by opacities. IS If visualization was inadequate, the reason was determined. Information regarding the number, size, type, and location (quadrantal and axial) of the retinal breaks as well as the location and extent of the RD were determined using a code similar to that of Cousins et al. 17 For example, the quadrantal location for the right eye was divided into 8 parts, in a clockwise direction. For a right eye, the parts were called superior (11- to I-o'clock positions), superonasal (1- to 2-0'clock positions), nasal (2- to 4-0'clock positions), inferonasal (4- to 5-0'clock positions), inferior (5- to 7-0'clock positions), inferotemporal (7- to 8-0'clock positions), temporal (8- to lO-o'clock positions), and superotemporal (10- to II-o'clock positions). The axial 10cation was classified into four parts: ora serrata, between ora serrata and equator, equator, and posterior to equator. The location of a break was determined by the position of the posterior edge of a tear or the middle of a hole.
The presence of proliferative vitreoretinopathy (PVR) was recorded and the classification established by the Retina Society was used. 19 The lens status of the fellow eye was recorded as phakic, pseudophakic, or aphakic. Vitreoretinal pathology in the fellow eye such as lattice-like degeneration, retinal breaks, and RD was recorded on a large fundus drawing. Any previous treatment was also noted. The data were analyzed using standard statistical methods. The relationships between categorical variables were examined using Pearson's chi-square technique. Differences were considered significant when the probability of their occurrence by chance was less than 5%.
Results The general characteristics of the 376 eyes of 361 patients included in this study are listed in Table 1. Fifteen patients who had both eyes involved were used in this study. In 3 of the 15 patients, the 2 eyes of the same patient were used in different groups. One patient had an aphakic RD in one eye and RD with an AC IOL in the other. One patient had an aphakic RD in one eye and RD with a PC IOL in the other. One patient had a bilateral pseudophakic RD, with an AC IOL and a PC IOL. Therefore, the total number of patients listed in Table 1 is 364. The group included 103 eyes with simple aphakia, 17 eyes with irisfixated IOL, 111 eyes with AC IOL, and 145 eyes with PC IOL. A greater proportion of males (62.4%) was observed. The mean age of the patients was 66.3 ± 9.8 years. There was no significant difference in the mean age of both sexes in each group. An insignificantly higher prevalence of right eyes (54.5%) was found. Intracapsular extractions were performed in the groups of simple aphakia, iris-fixated IOL, and AC IOL. All cases in the PC group underwent an extracapsular extraction. The complications of cataract extraction were few. Vitreous loss at the time of cataract extraction was noted as follows: 10 eyes (9.7%) in the aphakic group; 0 (0%) in the iris-fixated IOL group; 6 eyes (5.4%) in the AC IOL group; and 1 eye (0.7%) in the PC IOL group. In no case was an IOL operation aborted because of a surgical complication. In 20 of 376 eyes (5.3%) the posterior capsule was ruptured. Only 6 eyes (5.4%) of 111 in the AC IOL group had a history of posterior capsular rupture at the
Table 1. Distribution of Characteristics No. of patients No. of eyes Type of cataract extraction Intracapsular Extracapsular
Aphakia
IF
AC
PC
Total
98 (26.9%) 103 (27.4%)
14 (4.4%) 17 (4.5%)
108 (29.7%) 111 (29.5%)
142 (39.0%) 145 (38.6%)
364* (100%) 376 (100%)
91 (88.3%) 12 (11.7%)
12 (70.6%) 5 (29.4%)
102 (91.9%) 9 (8.1%)
0 145 (100%)
205 (54.5%) 171 (45.5%)
IF = iris-fixated intraocular lens; AC = anterior chamber intraocular lens; PC * 364 patients are listed instead of 361; see text for explanation.
454
=
posterior chamber intraocular lens.
Yoshida et al . Predisposing Factors of RD after Cataract Surgery Table 2. Interval Between Cataract Extraction and Retinal Detachment Interval (months) 24 Mean Standard deviation Total
Aphakia
IF
AC
PC
Total
17 (16.5%) 8 (7.8%) 18 (17.5%) 60 (58.2%) 52 51 103 (100%)
0 2 (11.8%) 2 (11.8%) 13 (76.4%) 51 31 17 (100%)
36 (32.4%) 37 (33.4%) 16 (14.4%) 22 (19.8%) 14 14 111 (100%)
35 (24.1%) 26 (17.9%) 41 (28.3%) 43 (29.7%) 20 19 145 (100%)
88 (23.4%) 73 (19.4%) 77 (20.5%) 138 (36.7%) 29 35 376 (100%)
IF = iris-fixated intraocular lens; AC = anterior chamber intraocular lens; PC = posterior chamber intraocular lens.
Table 3 shows associated preoperative complications. Fifteen eyes (13.5%) in the AC IOL group had vitreous herniation into the anterior chamber. The AC IOL group had a significantly higher (P < 0.05) prevalence of mild uveitis (18 eyes, 16.2%) than the aphakic group (7 eyes, 6.8%). The prevalence of uveitis in the PC IOL group (14 eyes, 9.7%) was insignificantly higher than in the aphakic group. The prevalence of vitreous hemorrhage was not significantly different among the four groups. The number of visible breaks is listed in Table 4. Retinal breaks were not detected in 45 of the total number of376 eyes (12.0%). The percentage of eyes with no retinal breaks found was significantly higher (P < 0.01) in the pseudophakic groups (40 eyes, 14.7%) than in the aphakic group (5 eyes, 4.9%). The aphakic group had a significantly higher prevalence (P < 0.01) of 4 or more breaks (17 eyes, 16.5%) than the pseudophakic groups (12 eyes, 4.4%). Table 5 shows the size of the largest break in the different groups. The aphakic group showed a significant prevalence (P < 0.05) of visible breaks smaller than one disc diameter (52 eyes, 50.5%) compared with the combined pseudophakic groups (99 eyes, 36.3%). As indicated in Table 6, the aphakic group exhibited significantly (P < 0.01) more cases with retinal holes (42 eyes, 42.9%) than the pseudophakic groups (59 eyes, 25.3%). Pseudophakic groups had significantly (P < 0.05) more cases with retinal tears (189 eyes, 81.1 %) than the aphakic group (69 eyes, 70.4%). As indicated in Table 7, the prevalence of cases that had peripheral breaks, either at the ora serrata or between the ora serrata and the equator, was significantly higher (P < 0.01) in the aphakic group (69 eyes, 67.0%) than in pseudophakic groups (141 eyes, 51.6%). There was no significant difference between
time of cataract surgery. Eight (5.5%) of 145 eyes in the PC IOL group had a history of posterior capsular rupture at the time of extracapsular cataract extraction. The rate of posterior capsular rupture at the time of cataract surgery was almost identical in the AC IOL group (5.4%) and the PC IOL group (5.5%). Table 2 indicates that the mean interval between cataract extraction and RD was insignificantly longer in the aphakic group (52 months) than in the AC IOL or PC IOL groups (14 and 20 months, respectively). More specifically, within 12 months after cataract extraction, 25 eyes (24.3%) with aphakia developed RD. In contrast, 136 eyes (50%) in the pseudophakic groups developed RD within 12 months, and this difference is significant (P < 0.01). The aphakic group had significantly (P < 0.01) more cases (60 eyes, 58.2%) with intervals longer than 24 months compared with the AC IOL (22 eyes, 19.8%) and PC IOL (43 eyes, 29.7%) groups. The status of the posterior capsule in the PC IOL group was studied. Fifty-six eyes (38.6%) had a damaged posterior capsule. Eight of these eyes (5.5%) had it at the time of cataract surgery. Forty-eight eyes (33.1%) in the PC group underwent Y AG capsulotomy before developing RD. Twenty-two of these 48 eyes (45.8%) developed RD within 6 months after Y AG treatment. The symptoms and their duration were studied. Fourteen of 103 eyes (13.6%) in the aphakic group had no symptoms, whereas in the IOL groups 7.0% (19 of 273 eyes) were without symptoms. This difference is significant (P < 0.05). Thus, symptoms are more likely to occur in pseudophakic than in aphakic eyes when RD develops. There was no significant difference between groups with regard to the duration of symptoms.
Table 3. Preoperative Complications (17)
(111)
(145)
PC
Total
(103)
30 (29.1%) 7 (6.8%) 18 (17.5%)
0 1 (5.8%) 2 (11.8%)
15 (13.5%) 18 (16.2%) 23 (20.7%)
6 (4.1%) 14 (9.7%) 30 (20.7%)
51 (13.6%) 40 (10.6) 73 (19.4%)
Aphakia Vitreous in anterior chamber Uveitis Vitreous hemorrhage
IF
AC
(376)
IF = iris-fixated intraocular lens; AC = anterior chamber intraocular lens; PC = posterior chamber intraocular lens.
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Ophthalmology
Table 4. Number of Visible Breaks No. of Breaks 0 1 2 3 4 or more Totals IF
=
IF
Aphakia (103)
(17)
AC (111)
(4.9%) (43.7%) (27.2%) (7.8%) (16.5%)
4 (23.5%) 7 (41.2%) 6 (35.3%) 0 0
12 (10.8%) 60 (54.1%) 26 (23.4%) 10 (9.0%) 3 (2.7%)
103 (100%)
17 (100%)
111 (100%)
5 45 28 8 17
iris-fixated intraocular lens; AC
=
anterior chamber intraocular lens; PC
=
PC (145) 24 71 35 6 9
Total (376)
(16.6%) (49.0%) (24.1%) (4.1%) (6.2%)
45 183 95 24 29
145 (100%)
(12.0%) (48.7%) (25.3%) (6.4%) (7.7%)
376 (100%)
posterior chamber intraocular lens.
Table 5. Size of Breaks Size of the Largest Break
Aphakia (103)
(17)
IF
AC (111)
T
he authors studied the characteristics of 376 eyes of 361 patients with primary retinal detachment (RD) and surgical aphakia (103 eyes) or pseudophakia (273 eyes). Of the pseudophakic eyes, 17 had an iris-fixated intraocular lens (IOL), 111 had an anterior chamber (AC) 10L, and 145 had a posterior chamber (PC) 10L. Of the PC 10L cases, 48 (33%) had undergone VAG capsulotomy, and 46% of them developed RD within 6 months after capsulotomy. The frequency of no breaks found in pseudophakic RD (15%) was significantly higher than in RD with simple aphakia (5%). The most frequent reasons were incomplete fundus view due to a small pupil in the irisfixated (83%) and the AC (44%) groups, and cloudiness of capsular remnants in the PC group (78%). In pseudophakic RD, sizable single tears, located more posteriorly than in RD with simple aphakia, were frequent. The authors speculate that in pseudophakic RD the retinal breaks may resemble those noted in phakic RD . Ophthalmology 1992; 99:453-459
Food and Drug Administration statistics 1 show that 1,174,000 intraocular lenses (IOLs) were implanted in the United States during the 12-month period ending January 1989. Ninety-three percent of these lenses were of the posterior chamber (PC) type while 7% were placed in the anterior chamber (AC). There was a rapid rise in the number of IOLs implanted between 1983 and 1987. Under these circumstances, the treatment of retinal detachment (RD) associated with pseudophakia, in particular the treatment of RD occurring in cases where PC IOLs have been used, is assuming great significance. A number of reports have been published to date on RD in aphakia. 2- 6 More recently, articles have appeared on RD in pseudophakia. 7- l7 The largest number ofpseudophakic RDs has been reported by Cousins et al 17 in 600 eyes
Originally received: April 30, 1991. Revision accepted: September 30, 1991. From the Eye Research Institute, and Retina Associates, Boston. Dr. Yoshida was on leave from the Department of Ophthalmology, Asahikawa Medical College, Japan. Reprint requests to Alex E. Jalkh. MD, Eye Research Institute of Retina Foundation, 20 Staniford St, Boston, MA 02114.
undergoing RD repair between 1974 and 1984. In this report, there were only 75 cases (12.5%) with PC IOLs, and 525 (87.5%) with either iris-fixated IOLs or AC IOLs. Because of this difference, the data provided by these authors are not applicable to the current situation where PC IOLs are mostly used. The current report presents a comparison of the characteristics of aphakic and pseudophakic RD observed in the same institution over the same period of time. Our study includes the largest number of cases ofpseudophakic RD in which PC IOLs were used.
Materials and Methods The Retina Associates allowed us to review the consecutive records of 376 eyes with primary aphakic or pseudophakic RD operated on between May 1982 and April 1989. All records contained the ocular history of the patient, visual acuity, anterior segment findings, and detailed fundus drawings. Cases of penetrating ocular trauma or diabetic retinopathy and those where the primary retina operation was performed elsewhere were excluded. In some instances, one or two details of information were
453
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Volume 99, Number 3, March 1992
not available, such as the duration of presenting symptoms or the interval between a Y AG capsulotomy and the occurrence of RD. Those cases were included in the analysis. Information was recorded on the cataract extraction, including the method of extraction, type of IOL inserted, and surgical complications, if any. The status of the posterior capsule, intact or not, a history of Y AG capsulotomy, and the interval between the capsulotomy and RD were carefully noted. This information was obtained, for each case, by a letter from the referring ophthalmologist. It was confirmed by precise preoperative biomicroscopic examination. The presence and duration of sUbjective symptoms were recorded, such as floaters, flashes, decreased vision, and visual field defects. Best corrected visual acuity was obtained at the initial visit. The presence or absence of macular detachment, vitreous hemorrhage, and vitreous gel herniation into the anterior chamber was noted. When present, a vitreous hemorrhage was examined by indirect ophthalmoscopy and recorded on a large fundus drawing. It was defined as hemorrhage found in the vitreous cavity that obstructed the view of major retinal vessels at least on part of their course. Preoperative uveitis was recorded according to the inflammatory reaction present in the AC. Detailed binocular indirect ophthalmoscopy was performed in every case to search for retinal breaks. The small pupil, binocular indirect ophthalmoscope was extremely useful in detecting retinal breaks when the pupil was small or partially obstructed by opacities. IS If visualization was inadequate, the reason was determined. Information regarding the number, size, type, and location (quadrantal and axial) of the retinal breaks as well as the location and extent of the RD were determined using a code similar to that of Cousins et al. 17 For example, the quadrantal location for the right eye was divided into 8 parts, in a clockwise direction. For a right eye, the parts were called superior (11- to I-o'clock positions), superonasal (1- to 2-0'clock positions), nasal (2- to 4-0'clock positions), inferonasal (4- to 5-0'clock positions), inferior (5- to 7-0'clock positions), inferotemporal (7- to 8-0'clock positions), temporal (8- to lO-o'clock positions), and superotemporal (10- to II-o'clock positions). The axial 10cation was classified into four parts: ora serrata, between ora serrata and equator, equator, and posterior to equator. The location of a break was determined by the position of the posterior edge of a tear or the middle of a hole.
The presence of proliferative vitreoretinopathy (PVR) was recorded and the classification established by the Retina Society was used. 19 The lens status of the fellow eye was recorded as phakic, pseudophakic, or aphakic. Vitreoretinal pathology in the fellow eye such as lattice-like degeneration, retinal breaks, and RD was recorded on a large fundus drawing. Any previous treatment was also noted. The data were analyzed using standard statistical methods. The relationships between categorical variables were examined using Pearson's chi-square technique. Differences were considered significant when the probability of their occurrence by chance was less than 5%.
Results The general characteristics of the 376 eyes of 361 patients included in this study are listed in Table 1. Fifteen patients who had both eyes involved were used in this study. In 3 of the 15 patients, the 2 eyes of the same patient were used in different groups. One patient had an aphakic RD in one eye and RD with an AC IOL in the other. One patient had an aphakic RD in one eye and RD with a PC IOL in the other. One patient had a bilateral pseudophakic RD, with an AC IOL and a PC IOL. Therefore, the total number of patients listed in Table 1 is 364. The group included 103 eyes with simple aphakia, 17 eyes with irisfixated IOL, 111 eyes with AC IOL, and 145 eyes with PC IOL. A greater proportion of males (62.4%) was observed. The mean age of the patients was 66.3 ± 9.8 years. There was no significant difference in the mean age of both sexes in each group. An insignificantly higher prevalence of right eyes (54.5%) was found. Intracapsular extractions were performed in the groups of simple aphakia, iris-fixated IOL, and AC IOL. All cases in the PC group underwent an extracapsular extraction. The complications of cataract extraction were few. Vitreous loss at the time of cataract extraction was noted as follows: 10 eyes (9.7%) in the aphakic group; 0 (0%) in the iris-fixated IOL group; 6 eyes (5.4%) in the AC IOL group; and 1 eye (0.7%) in the PC IOL group. In no case was an IOL operation aborted because of a surgical complication. In 20 of 376 eyes (5.3%) the posterior capsule was ruptured. Only 6 eyes (5.4%) of 111 in the AC IOL group had a history of posterior capsular rupture at the
Table 1. Distribution of Characteristics No. of patients No. of eyes Type of cataract extraction Intracapsular Extracapsular
Aphakia
IF
AC
PC
Total
98 (26.9%) 103 (27.4%)
14 (4.4%) 17 (4.5%)
108 (29.7%) 111 (29.5%)
142 (39.0%) 145 (38.6%)
364* (100%) 376 (100%)
91 (88.3%) 12 (11.7%)
12 (70.6%) 5 (29.4%)
102 (91.9%) 9 (8.1%)
0 145 (100%)
205 (54.5%) 171 (45.5%)
IF = iris-fixated intraocular lens; AC = anterior chamber intraocular lens; PC * 364 patients are listed instead of 361; see text for explanation.
454
=
posterior chamber intraocular lens.
Yoshida et al . Predisposing Factors of RD after Cataract Surgery Table 2. Interval Between Cataract Extraction and Retinal Detachment Interval (months) 24 Mean Standard deviation Total
Aphakia
IF
AC
PC
Total
17 (16.5%) 8 (7.8%) 18 (17.5%) 60 (58.2%) 52 51 103 (100%)
0 2 (11.8%) 2 (11.8%) 13 (76.4%) 51 31 17 (100%)
36 (32.4%) 37 (33.4%) 16 (14.4%) 22 (19.8%) 14 14 111 (100%)
35 (24.1%) 26 (17.9%) 41 (28.3%) 43 (29.7%) 20 19 145 (100%)
88 (23.4%) 73 (19.4%) 77 (20.5%) 138 (36.7%) 29 35 376 (100%)
IF = iris-fixated intraocular lens; AC = anterior chamber intraocular lens; PC = posterior chamber intraocular lens.
Table 3 shows associated preoperative complications. Fifteen eyes (13.5%) in the AC IOL group had vitreous herniation into the anterior chamber. The AC IOL group had a significantly higher (P < 0.05) prevalence of mild uveitis (18 eyes, 16.2%) than the aphakic group (7 eyes, 6.8%). The prevalence of uveitis in the PC IOL group (14 eyes, 9.7%) was insignificantly higher than in the aphakic group. The prevalence of vitreous hemorrhage was not significantly different among the four groups. The number of visible breaks is listed in Table 4. Retinal breaks were not detected in 45 of the total number of376 eyes (12.0%). The percentage of eyes with no retinal breaks found was significantly higher (P < 0.01) in the pseudophakic groups (40 eyes, 14.7%) than in the aphakic group (5 eyes, 4.9%). The aphakic group had a significantly higher prevalence (P < 0.01) of 4 or more breaks (17 eyes, 16.5%) than the pseudophakic groups (12 eyes, 4.4%). Table 5 shows the size of the largest break in the different groups. The aphakic group showed a significant prevalence (P < 0.05) of visible breaks smaller than one disc diameter (52 eyes, 50.5%) compared with the combined pseudophakic groups (99 eyes, 36.3%). As indicated in Table 6, the aphakic group exhibited significantly (P < 0.01) more cases with retinal holes (42 eyes, 42.9%) than the pseudophakic groups (59 eyes, 25.3%). Pseudophakic groups had significantly (P < 0.05) more cases with retinal tears (189 eyes, 81.1 %) than the aphakic group (69 eyes, 70.4%). As indicated in Table 7, the prevalence of cases that had peripheral breaks, either at the ora serrata or between the ora serrata and the equator, was significantly higher (P < 0.01) in the aphakic group (69 eyes, 67.0%) than in pseudophakic groups (141 eyes, 51.6%). There was no significant difference between
time of cataract surgery. Eight (5.5%) of 145 eyes in the PC IOL group had a history of posterior capsular rupture at the time of extracapsular cataract extraction. The rate of posterior capsular rupture at the time of cataract surgery was almost identical in the AC IOL group (5.4%) and the PC IOL group (5.5%). Table 2 indicates that the mean interval between cataract extraction and RD was insignificantly longer in the aphakic group (52 months) than in the AC IOL or PC IOL groups (14 and 20 months, respectively). More specifically, within 12 months after cataract extraction, 25 eyes (24.3%) with aphakia developed RD. In contrast, 136 eyes (50%) in the pseudophakic groups developed RD within 12 months, and this difference is significant (P < 0.01). The aphakic group had significantly (P < 0.01) more cases (60 eyes, 58.2%) with intervals longer than 24 months compared with the AC IOL (22 eyes, 19.8%) and PC IOL (43 eyes, 29.7%) groups. The status of the posterior capsule in the PC IOL group was studied. Fifty-six eyes (38.6%) had a damaged posterior capsule. Eight of these eyes (5.5%) had it at the time of cataract surgery. Forty-eight eyes (33.1%) in the PC group underwent Y AG capsulotomy before developing RD. Twenty-two of these 48 eyes (45.8%) developed RD within 6 months after Y AG treatment. The symptoms and their duration were studied. Fourteen of 103 eyes (13.6%) in the aphakic group had no symptoms, whereas in the IOL groups 7.0% (19 of 273 eyes) were without symptoms. This difference is significant (P < 0.05). Thus, symptoms are more likely to occur in pseudophakic than in aphakic eyes when RD develops. There was no significant difference between groups with regard to the duration of symptoms.
Table 3. Preoperative Complications (17)
(111)
(145)
PC
Total
(103)
30 (29.1%) 7 (6.8%) 18 (17.5%)
0 1 (5.8%) 2 (11.8%)
15 (13.5%) 18 (16.2%) 23 (20.7%)
6 (4.1%) 14 (9.7%) 30 (20.7%)
51 (13.6%) 40 (10.6) 73 (19.4%)
Aphakia Vitreous in anterior chamber Uveitis Vitreous hemorrhage
IF
AC
(376)
IF = iris-fixated intraocular lens; AC = anterior chamber intraocular lens; PC = posterior chamber intraocular lens.
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Ophthalmology
Table 4. Number of Visible Breaks No. of Breaks 0 1 2 3 4 or more Totals IF
=
IF
Aphakia (103)
(17)
AC (111)
(4.9%) (43.7%) (27.2%) (7.8%) (16.5%)
4 (23.5%) 7 (41.2%) 6 (35.3%) 0 0
12 (10.8%) 60 (54.1%) 26 (23.4%) 10 (9.0%) 3 (2.7%)
103 (100%)
17 (100%)
111 (100%)
5 45 28 8 17
iris-fixated intraocular lens; AC
=
anterior chamber intraocular lens; PC
=
PC (145) 24 71 35 6 9
Total (376)
(16.6%) (49.0%) (24.1%) (4.1%) (6.2%)
45 183 95 24 29
145 (100%)
(12.0%) (48.7%) (25.3%) (6.4%) (7.7%)
376 (100%)
posterior chamber intraocular lens.
Table 5. Size of Breaks Size of the Largest Break
Aphakia (103)
(17)
IF
AC (111)
