Klaus Lucke, Silvia Bopp (Augenklinik Universitätsallee, Bremen, Germany)

Advantages:

The question whether refractive lens exchange might increase the risk of retinal detachment in myopic eyes is still discussed controversially. Since combined anterior/posterior segment surgery is routine procedure in our hands, and since the vitreous is usually the culprit in the pathogenesis of retinal detachment we investigated the possibility that removing the vitreous at the time of refractive lens exchange might be instrumental in reducing the incidence of retinal detachment.

Methods:

We retrospectively analyzed the charts of 26  myopic eyes of 18 patients that underwent combined lens exchange/vitrectomy. In most instances there was some degree of cataract and the patients were complaining of significant vitreous opacities. Axial lengths ranged from 25 to 34mm and IOLs implanted had +1dpt to +18dpt. In all eyes we exerted great effort to remove the peripheral vitreous under deep indentation as thoroughly as possible.

Effectiveness / Safety:

In 5 eyes we found intraoperatively some need for laser or cryo, and 4 eyes needed Nd:Yg capsulotomy later in the follow-up period. Apart from that surgery and postoperative periods were uneventful in all eyes. In particular we saw no case of retinal detachment or cystoid macular edema. All eyes developed satisfactory visual function.

Take-Home Message:

Adding a thorough vitrectomy to a cataract operation or refractive lens exchange in myopic eyes might be instrumental in reducing the risk of retinal detachment in the postoperative course.