Friday, April 19, 2024

Retinal Detachment After Cataract Surgery

Retinal Tear Or Detachment

Detached Retina after Cataract Surgery

In rare cases, PVD from cataract surgery can lead to a tear in the retina. This can happen if vitreous fibers continue to tug on the retina during or after surgery.

The force applied to the retina can cause a tear to form. Retinal tears can progress to retinal detachment. Both conditions can lead to vision loss in the affected eye. Floaters can be a symptom of a retinal tear or detachment.

How Does Cataract Surgery Lead To Retinal Detachment

There is a higher risk of retinal detachment after cataract surgery between five and 16 per 1,000 cataract surgeries, depending on which study you use. In contrast, the risk among those with normal eyes is about five per 100,000.

However, the risk has decreased since ultrasound has been used to break up the lens before removing it. Up until 1990, the lens was removed in one piece, including its capsule. Without the capsule in position, the vitreous gel behind it moved forward. That placed some traction on the retina the vitreous pulled on it and tore it in some cases, or detached it.

Ultrasound fragments the lens but does not affect its capsule. Your IOL is positioned inside that same capsule and that keeps the vitreous gel in place. Sometimes during cataract surgery, the capsule is broken. That is a potential complication of the surgery. Then the vitreous moves forward and can lead to a retinal tear or detachment.

Symptoms Of Retinal Detachment

There is no pain, but you would notice changes in your vision:

  • Light flashes in one or both eyes
  • A darkness or shadow over part of your visual field
  • Sudden blurriness
  • Sudden appearance of floaters

If you notice any of these changes, contact your eye doctor immediately. Do not wait in hopes that your vision will improve.

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Age Sex Influence Risk For Retinal Detachment After Cataract Surgery

Morano MJ, et al. Incidence and risk factors for retinal detachment after cataract surgery: An IRIS Registry analysis. Presented at: American Academy of Ophthalmology meeting Sept. 30Oct. 3, 2022 Chicago.

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CHICAGO Risk factors for rhegmatogenous retinal detachment following cataract surgery include younger age, white race, male sex and lattice degeneration, according to a poster presented at the American Academy of Ophthalmology meeting.

Using the IRIS Registry, Michael J. Morano, MD, and colleagues conducted a retrospective study of 3,177,195 eyes of 1,983,712 patients at Wills Eye Hospital and found that one in 500 cataract surgeries in patents aged 40 or older resulted in rhegmatogenous retinal detachment .

Large databases like the IRIS Registry offer an opportunity to better quantify the risk of complications and determine the risk factors associated with these complications, Morano said.

Of the eyes studied, 6,690 developed RRD within a year of cataract surgery. RRD occurred at a median of 139 days after cataract surgery, with 15.9% occurring within 30 days, 37.3% occurring within 90 days and 59.9% occurring within 180 days.

The incidence rate of RRD in men was 0.37%, while it was only 0.11% in women. The incidence rate in white patients was 0.23%, while it was 0.13% in Black patients.

Retinal Detachment Rates After Cataract Or Presbyopic Lens Extraction

CME 4 months following cataract surgery with serous retinal detachment ...

Malaika David, Associate Editor

This month, the Peer Review column focuses on the incidence of retinal detachment following cataract surgery. While the rate for all cataract surgery remains low, it should be considered in relation to the volume of cataract procedures performed annually in the United States. Based on data published by the American Society of Cataract and Refractive Surgery in 2005, ophthalmologists now perform approximately 3 million cataract surgeries annually in this country.1 At a conservative rate of 0.5% of retinal detachments following cataract surgery, at least 15,000 detachments occur nationally every year after cataract surgery. As the age-adjusted rate of retinal detachment for the general population over 50 years old approaches 0.02%,2 we ophthalmologists should be aware that cataract surgery is increasing their risk of detachment by as much as 10-fold. In addition to age as a risk factor, myopia greater than 5.00 or 6.00 D has been reported to account for up to 67% of all retinal detachments after cataract surgery, with the cumulative incidence rate closer to 2% annually.

I hope you enjoy this installment of Peer Review, and I encourage you to seek out and review the articles in their entirety at your convenience.

Mitchell C. Shultz, MD, section editor

  • Leaming D.Practice styles and preferences of ASCRS member2003 survey.J Cataract Refract Surg.2004 30:892900.
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    Post Detached Retina Surgery Followed With Cataracts And Eye Scarring

    Hi,I had emergency detached retina surgery 5 weeks ago. Last week I was told there is now scarring developing along with cataracts. Surgeon know wants to see me every 5 days to check on the progress of the scarring to see if a second surgery is needed now,cataracts to be dealt with later. I still have 20% of the gas bubble left.Had a buckle which is driving me insane with the itching. My major concern is will my sight ever be the same down in the future. I presently don’t feel safe driving.My vision in the eye is very distorted, blurred and makes me very dizzy.I felt my Dr. Rushed me at the appointment today saying time will tell,too soon to know .I’m not sure if I should be seeking another specialist. Really need feedback from someone whose been in my place.

    Hi Jackie, I can understand your concern. Eyesight is precious and it is hard to know what requires time to heal and what might be permanent. Feeling rushed by the doctor doesn’t help to allay those concerns. I read in this article that multiple surgeries are sometimes necessary. Retinal Detachment Repair

    I’m tagging @imallears@jaguar737 and @dsh33782 on this discussion as they have some experience with retinal detachment surgery.

    @bjackie, do you know if you had some scarring before the surgery?


    FL Mary

    Best to you,

    How Does Cataract Surgery Result In Retinal Detachment

    Currently, surgeons break a cataract into fragments before removing it via suction from the eye. However, before the advent of ultrasound-assisted cataract surgery, the cataract-affected lens was removed as a single piece, including the capsule that housed the lens. With the capsule removed, the vitreous gel behind the capsule moved forward, pulling the retina along with it. This, in turn, sometimes caused the retina to tear or to become detached altogether.

    In the era of modern cataract surgery, retinal detachment has become a far less common surgical complication however, it remains a potential risk. The risk of retinal detachment as a result of cataract surgery increases if:

    • The capsule is broken during surgery
    • The patient is extremely nearsighted
    • Remnants of the cataract remain in the vitreous gel after surgery
    • There is a family history of retinal detachment
    • The patient had previously suffered retinal detachment
    • The patient has another eye condition such as diabetic retinopathy

    Some patients develop what is colloquially known as a secondary cataract after cataract surgery. This is not actually a cataract at all – once the eyes lens has been removed, a cataract can no longer form – but a clouding of the remaining capsule. This condition is treated with a laser procedure called Nd:YAG posterior capsulotomy.

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    Risk Factors For Retinal Detachment Repair After Pediatric Cataract Surgery In The United States

    • Isdin OkeCorrespondenceCorrespondence: Isdin Oke, MD, Department of Ophthalmology, Boston Childrens Hospital, 300 Longwood Avenue, Boston, MA 02115.
    • Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CaliforniaDepartment of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
    • Angeline NguyenAffiliationsDepartment of Ophthalmology, The Vision Center, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

    Treatment For Cataract Surgery Complications: Retinal Detachment

    Can You Have Cataract Surgery after Retinal Detachment?

    At Retina Associates, LLC, we proudly use only the latest, most advanced technologies and techniques to provide our patients with eye care services of the most surpassing quality. Among the advanced procedures we provide are surgeries to treat retinal detachment. Although relatively rare, retinal detachment is a very real risk of cataract surgery, occurring in roughly 1 percent of post-operative cataract surgery patients. Retinal detachment does not necessarily occur immediately after surgery it can happen at any point in the patients lifetime after cataract surgery.

    Our skilled retinal surgeons are able to address this most dangerous and vision-threatening of cataract surgery complications at our Kansas City practice through several surgical techniques. If you or someone you love has undergone cataract surgery and is currently experiencing any of the symptoms of retinal detachment, it is imperative that you do not delay in seeking treatment. If left untreated, retinal detachment can cause serious and permanent damage to your vision. Visit our renowned eye surgeons at Retina Associates, LLC today.

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    Peak Occurrence Of Retinal Detachment Following Cataract Surgery: A Systematic Review And Pooled Analysis With Internal Validation

    Rabea Kassem


    Introduction. Timing of retinal detachment following cataract surgery is of importance for both diagnostic and prognostic factors. However, results on RD onset-time following cataract surgery have been conflicting. Method. A systematic pooled analysis of the literature regarding timing of retinal detachment following cataract surgery. Outcomes were verified against an independent dataset. Results. Twenty-one studies, reporting on rates of RD in 3,352,094 eyes of 2,458,561 patients, met our inclusion criteria and were included in the analysis. The mean pooled time to RD following surgery was 23.12 months with high heterogeneity between studies . Meta-analytic pooling for the risk of retinal detachment revealed a risk of 1.167% . A retrospective chart review identified 54 pseudophakic RD cases . The 95% confidence interval for the mean time to RD was 3.16.75 years. . The interval between cataract surgery and RD in a pooled analysis revealed a mean time of approximately 1.52.3 years. However, there was high variability between studies. Validation based on our local results showed similar yet slightly longer time frames. Timing of pseudophakic retinal detachment might direct appropriate follow-up, assisting in earlier detection.

    1. Introduction

    2. Methods

    2.1. Systematic Review
    2.1.1. Literature Searches Methods
    2.1.2. Eligibility Criteria
    2.1.3. Screening and Synthesis
    2.1.4. Statistical Analysis
    2.2. Retrospective Validation Analysis

    3. Results

    Family History And Refractive Error Are But Two Risk Factors That Increase The Risk Of A Retinal Detachment Here Retinal Experts Discuss Whenor Ifto Treat Tears And Holes

    Retinal detachments are more likely to occur in patients with higher myopia, and the risk increases if theres a family history of RD or if a patients fellow eye has had one. In these patients, retinal specialists recommend extra vigilance when looking at the peripheral retina during normal pre-op exams before cataract surgery. Refractive lens exchange patients undergoing an IOL exchange are also at a higher risk. Complicated cataract surgerycases involving vitreous loss or capsular rupturealso puts the patient at an increased risk of developing an RD. Another patient group at risk is people who have undergone refractive surgery and no longer consider themselves myopic. Anatomically, those eyes are still longer and at risk, retina specialists said.

    Sometimes, regardless of how meticulous the surgeon is, an RD may still occur.

    Educating the patient about the signs and symptoms of RD can go a long way toward catching a tear before it becomes a full-blown detachment, experts said.

    If patients are aware of the signs and symptoms of RD, theyll be less likely to ignore floaters, said David S. Boyer, M.D., clinical professor of ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles.

    Patients who seek treatment too late in the course of the disease because theyre unfamiliar with the symptoms are most likely to have poor visual outcomes as well, Dr. Stewart said. Once central vision has been impacted by an RD, the outcomes are not as good.

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    When Can You Have Cataract Surgery After Vitrectomy

    There is not a specific amount of time you should wait to have cataract surgery after undergoing vitrectomy. The timing should be based on individual consultation with your doctors. However, the American Academy of Ophthalmology recommends giving your eyes at least three months to heal from one eye surgery before committing to a second operation if possible.

    Cataract Surgery And Retinal Detachment

    Retinal Detachment

    Retinal Detachment is a severe vision-threatening emergency and requires immediate surgical treatment. The retina is the eyes camera film and forms the inside back surface of the eyeball. Please see How the Eyes Work for more details.

    Beneath the retina is a layer filled with blood vessels that supply the retina with nourishment. If the retina is torn in one small place, and is treated fairly soon, it will likely regain full function. If a larger retinal area is detached from the blood supply for long enough, its cells will die for lack of oxygen and nutrients. This is why retinal detachment is a medical emergency.

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    What To Treat And When

    Any suspicious lesion in the retinal periphery bears examination and investigation, Dr. Stewart said. Retinal tears should be treated before the patient undergoes cataract surgery, and Dr. Boyer recommended allowing the tear to heal for several weeks before any other surgery.

    Tears put patients at a marked increased risk of developing a detachment. It takes about 1718 days to get an 80% bond if youre using lasers to treat, he said.

    Most horseshoe retinal tears need to be treated immediately, Dr. Moshfeghi said, unless theres adequate pre-existing retinal scarring.

    Drs. Fawzi and Stewart are slightly more cautious, noting theyll follow rather than treat asymptomatic patients. In most cases, the incidental finding of a hole in an asymptomatic patient with no strong family history or no underlying medical conditions probably doesnt need treatment, Dr. Stewart said.

    Everyone agreed, however, that tears are more worrisome than full-on holes, regardless of geography.

    People can go their entire life with an atrophic round hole and never need treatment, Dr. Moshfeghi said.

    Postoperative Cataract Surgery Risk Factors Following Vitrectomy

    Cataract surgery can be effective and successful after vitrectomy when considerations are made during the operation and close watch is taken postoperatively. Having cataract surgery after vitrectomy does increase potential complications and risk factors, depending on why the vitrectomy procedure was performed.

    If vitrectomy was done to fix macular problems, cataract surgery can raise the risk for cystoid macular edema. You may need to be monitored closely and take anti-inflammatory drops for a longer period of time after surgery.

    If vitrectomy was performed to repair a detached retina, there is a slightly greater chance of a future recurrent retinal detachment after cataract surgery however, since the vitreous gel has been removed from the eye this not always the case. It can take longer for your eyes to heal after cataract surgery than the traditional timeline of a few weeks.

    Talk to your doctor about the safety and potential prognosis for your cataract surgery after vitrectomy. Typically, it is best to wait until cataracts are interfering with your daily life before having them surgically removed.

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    What Are The Symptoms Of Retinal Detachment

    You will most likely not experience any pain or discomfort as a result of retinal detachment, which means that you will have to be extremely attentive to the following visual changes:

    • A darkening of part of your visual field, as though a shadow had fallen over it
    • A sudden onset of blurriness
    • Light flashes in your field of vision
    • Floaters in your field of vision

    If you notice any of these changes in your vision, do not hesitate to contact our practice. Do not assume that these are normal side effects of cataract surgery and that your vision will improve with time. The key to treating retinal detachment is to take timely action against it. The longer you delay in seeking treatment, the more likely your vision will sustain permanent and serious damage.

    Greater Risk Of Retinal Tears After Cataract Surgery Linked To Better Preoperative Va

    Detached Retina: Vitrectomy

    Men and patients aged 65 years and younger had higher incidences of retinal tears.

    New findings suggest patients with better overall preoperative visual acuity, eyes with longer axial length, and eyes with intraoperative complications were at an increased risk of retinal tears following cataract surgery.

    The data show male patients and those aged younger than 65 years old had a higher incidence of retinal tears, compared to women and those aged 65 years and older, respectively.

    Careful counseling is important, and postoperative follow-up is advised for patients identified preoperatively as being at an elevated risk of retinal tears, given the large rate of asymptomatic retinal tears and high rate of progression to retinal detachment, wrote study author Karen Christopher, MD, University of Colorado School of Medicine.

    Christopher aimed to describe the incidence and identify risk factors for retinal tears among a patient population who underwent cataract phacoemulsification surgery. The retrospective case-control study included patients who underwent cataract phacoemulsification surgery between January 2014 and December 2019 at an academic eye center in Colorado.

    They identified the main outcome measures as the diagnosis of retinal tears within 1 year after cataract surgery. Incidences of retinal tears were analyzed by demographics, comorbid medical history, ocular characteristics, surgical characteristics, and intraoperative complications.

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    Whats The Outlook For People With Floaters

    The outlook for floaters is generally good. In some people, floaters may go away over a period of weeks or months. In other cases, you may adapt to the presence of floaters and not notice them as much.

    People with very severe floaters that impact their vision and daily life may be treated with vitrectomy. However, this procedure has its own risks and side effects, so be sure to discuss these with an eye doctor first.

    Retinal tears or detachments can potentially lead to permanent vision loss. However, treatment with a procedure or surgery often works well if these conditions are detected and addressed early.

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