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Z.K. Segal, C.D. Witherspoon, R.E. Morris, L. Tehranchi, P. Scharper; Retinal Detachment Prophylaxis for Eyes Undergoing Removal of Retained Lens Fragments . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4205.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the long–term efficacy of peripheral indirect ophthalmoscopic (IDO) laser cerclage as prophylaxis against retinal detachment in eyes undergoing pars plana vitrectomy (PPV) for the removal of retained lens fragments after complicated cataract extraction.
A retrospective chart review was conducted of all patients who underwent PPV for the removal of retained lens fragments with peripheral IDO laser cerclage after complicated cataract extraction between January 1st, 1995 and December 31st, 2000. Laser spots were placed between the ora and the equator, with one spot separation, creating a new ora or "ora secunda." This study includes all patients who were identified through a search of a computerized database with a primary diagnosis of PPV for retained lens fragments.
Between January 1st, 1995 and December 31st, 2000, 110 charts were reviewed and included. Of those, accurate information was obtained on 78 eyes of 78 patients. 55% were male and 45% were female. The average age was 72 years (51–91 years). The average time between the initial cataract procedure and the PPV with prophylactic IDO laser cerclage was 2 weeks (1day–4 weeks). No post–operative complications were found to occur from either the vitrectomy or the peripheral laser cerclage. The average follow–up period was 6 years (1–10 years). Only 1 eye of 78 (1.3%) was found to have an (extramacular) retinal detachment after PPV with peripheral laser cerclage. This eye then underwent successful reatthachment surgery.
Although the percentage of all cataract surgeries resulting in retained lens fragments is estimated to be between 0.3–1.1%, the absolute number of these cases is formidable. One of the most frequent causes of poor long–term vision cited in the literature is the occurrence of retinal detachment after PPV. The literature overall reports that approximately 7% of patients develop a rhegmatogenous retinal detachment after PPV for retained lens fragments. The authors here report that the long–term incidence of retinal detachment after PPV with peripheral IDO laser cerclage prophylaxis was found to be 1.3% with an average follow–up of 6 years. This finding was found to be statistically significant when compared to the overall findings in the literature (P=0.05). It appears that peripheral IDO laser cerclage at the time of lens fragment removal could substantially decrease the incidence of post–operative retinal detachment in this set of patients who have already suffered an iatrogenic complication requiring recurrent surgery.
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