The increase of pseudophakic retinal detachments has raised the question about its risk factors. According to the literature, complicated cataract surgery rarely contributes to pseudophakic retinal detachment. Nevertheless, we noted a high proportion of defects in the capsular barrier among our patients. We therefore reevaluated our charts for perioperative and epidemiologic risk factors for pseudophakic retinal detachment.
Patients: Seventy-six patients with pseudophakic retinal detachment after extracapsular cataract operation with intraocular lens implantation were referred to the Ophthalmology Department of Freiburg University between 1986 and 1991. Their case records were analyzed for possible risk factors for retinal detachment.
Results: When retinal detachment developed, posterior lens capsule was not intact in 52/76 eyes (68%), the highest rate published so far. In 37 eyes capsular rupture occurred during cataract surgery, in 16 eyes followed by vitreous prolapse and in 9 eyes with persistent vitreous incarceration. Three eyes had vitreous prolapse via zonula. In 10 eyes YAG laser capsulotomy preceded detachment, and in 2 eyes capsular rupture occurred during an aspiration procedure for secondary cataract. The high proportion of intraoperative capsular ruptures is understandable if we assume a 2% risk of intraoperative capsular rupture, followed by a 20-fold increase in retinal detachment. The latency between cataract surgery and retinal detachment was 22 months after uncomplicated surgery, after YAG laser capsulotomy 13.5 and after intraoperative capsular rupture 10 months (medians).
Conclusion: Vitreal complications in cataract surgery facilitate the development of retinal detachment. The incidence of defect posterior capsules and vitreal complications among patients with pseudophakic retinal detachments can be explained by assuming a 10- to 20-fold increase in retinal detachments after these complications. In cases of capsular or zonular rupture, all means, including prophylactic vitrectomy of vitreal strands, should be used to avoid permanent vitreous traction. However, the rate of retinal detachments after YAG laser capsulotomies only minimally surpassed the rate after uncomplicated cataract surgery. The risk for retinal detachment is not determined so much by the capsular defect itself. It is determined rather by the circumstances in which it occurred and by the grade of vitreal disturbance.