Pseudophakic Retinal Detachment – A Retrospective Audit

Pseudophakic Retinal Detachment – A Retrospective Audit

T E Jackson, D Rathore, A B Callear (Shrewsbury, UK)

Introduction:

Pseudophakic retinal detachment is a serious complication of cataract surgery with an estimated incidence of 0.6-1.7% in the first postoperative year. The management of pseudophakic retinal detachment can be challenging as the tears are often small and anteriorly placed and the peripheral view may be limited by anterior or posterior capsular fibrosis and lens edge aberrations. The surgical treatment of pseudophakic retinal detachment remains controversial with the two main techniques being scleral buckling and pars plana vitrectomy with or without scleral buckling. We report the characteristics and outcomes of pseudophakic retinal detachment surgery by a single surgeon.

Methods:

A retrospective audit of eyes with pseudophakic retinal detachments undergoing surgical treatment at the Royal Shrewsbury Hospital between January 1999 and December 2008.

Results:

54 eyes with pseudophakic retinal detachment were identified. 59% were macular-off retinal detachments. Tears were identified in 96% of eyes with 39% having multiple tears. 31% underwent scleral buckling with a success rate of 88%. 43% underwent vitrectomy with a success rate of 65%. 26% underwent vitrectomy and scleral buckling combined with a success rate of 64%. 28% of eyes subsequently re-detachmented. In the eyes that re-detached, 53% were found to have new breaks while in 33% no new breaks were evident. In 4% a macular hole was found to be open. The average time from cataract surgery to retinal detachment was 3 years. 67% had undergone uncomplicated phacoemulsification cataract extraction, 9% had undergone uncomplicated extracapsular cataract extraction, 17% had undergone cataract surgery complicated by a posterior capsule tear. 33% had undergone previous Nd:YAG capsulotomy.

Conclusion:

In this case series, the use of scleral buckling for the management of pseudophakic retinal detachment had a higher success rate (88%) than the use of vitrectomy (65%) or the use of vitrectomy and scleral buckling combined (64%).