Refractive lens exchange surgery increases retinal detachment risk

Chicago-Retinal detachment is a significant risk in refractive lens exchange surgery, said Emanuel S. Rosen, MD, at the refractive surgery subspecialty day meeting sponsored by the International Society of Refractive Surgery of the American Academy of Ophthalmology.

Dr. Rosen, visiting professor, department of vision sciences, University of Manchester, England, presented a meta-analysis of papers published over the past 11 years that have investigated the incidence of retinal detachment after lens extraction and IOL implantation in myopic eyes. A total of 21 papers were identified that included 6,522 eyes. In that series, 117 eyes suffered pseudophakic retinal detachment (1.8%, 1 in 56 eyes). Among the individual papers, the retinal detachment rates ranged from 0 to 8.1%.

Complicated surgery appeared to increase the risk-one study highlighted a significant increased risk in eyes that had sustained capsular tear, although Nd:YAG laser capsulotomy appeared to have no effect. In another study now in press, younger age was identified as a risk factor. In that retrospective review from New Zealand of nearly 1,800 eyes that underwent Kelman phacoemulsification, the rate of retinal detachment was 1.17% overall and 0.64% in persons over age 70. However, in the age group of persons under 50 years old (who would be representative of the refractive lens exchange population), the retinal detachment rate was 5.17%.

“Available evidence indicates the risk of retinal detachment jumps 100-fold after Kelman phacoemulsification and 200-fold in myopic eyes relative to the general population,” Dr. Rosen said. “Rate variations in available studies may be due to differences between them in a number of variables, making it difficult to reach definitive conclusions.

“Therefore, long-term case control studies of a high volume of myopic eyes undergoing refractive lens exchange would be very valuable to help us to better define the risk,” Dr. Rosen said.