FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2076420801> ?p ?o ?g. }

• W2076420801 endingPage "701" @default.
• W2076420801 startingPage "697" @default.
• W2076420801 abstract "The success of small corneal incision Kelman phacoemulsification (KPE) lens extraction and intraocular lens (IOL) replacement for cataract pathology has spawned the field of refractive lens exchange (RLE). As the name implies, this is a surgical process designed to adjust ametropia to an individual's requirement and, almost by definition, aimed at patients in early and late middle age. It follows that with longer life expectancy, we as a profession should be aware of the procedure's inherent short- and long-term risks. To aid that process, we need to accumulate and study the evidence, ideally by a prospective case-control clinical trial. This is generally impractical in a refractive surgical process, not least because of rapid changes in technology. What is available is retrospective study of patient cohorts, and this has other problems because the variables in each study are considerable. Of the 2 major types of ametropia, hyperopia excluding pathologic hyperopia offers the best benefit/risk for RLE. Infection draws no distinction between myopia and hyperopia, but complications leading to chronic loss of vision are unusual according to the literature and personal experience.1 The benefits of emmetropia to those experiencing premature-onset presbyopia and spectacle- or contact-lens-dependent vision extend beyond sight restoration to encompass general well-being. Large (myopic) eyes are different in terms of benefit/risk ratio, as a survey of the literature of the past 12 years indicates.2–34 Although the variables in the mainly retrospective studies are many, the coherent message is that the risk for rhegmatogenous retinal detachment (RRD) lies between 2% and 8% (Figure 1). Colin et al.32–34 report in a cohort of 52 patients, the risk for RRD was 8%. Close evaluation of the data suggests that this figure might be misleading as only 44 patients were followed for 8 years and 4 detachments occurred, 2 in 1 patient. Whereas most reports suggest figures from 0% to 4%,2–34 the lack of consistent data, eg, time of follow-up, variable neodymium:YAG (Nd:YAG) capsulotomy rate, axial length of eyes, and complications, leave scope for doubt in exact interpretation of the data. The study by Ripandelli et al.31 is to be commended for in this prospective series, there was a matched control group. The latter had an RRD rate of 1.2%, whereas the myopic eyes had a rate of 8%, matching the data of Colin et al.Figure 1: Incidence of RRD, risk factors, and odds ratios.For comparative purposes, the rate of RRD in unoperated eyes in a general population is 0.0118% according to Polkinghorne and Craig.35 In a later study by these authors,36 the RRD rate in a general population having KPE lens extraction and IOL implantation was 1.17%, a figure closely matching that of Ripandelli et al.'s control group. Age considerations showed that in patients younger than 50 years, the rate rose to more than 5%; in patients older than 70 years, it dropped to 0.7%. Desai37 draws attention to the relationship between cataract extraction and RRD. Perkins38 suggests that the annual rate of RRD in unoperated eyes with greater than 10 diopters (D) of myopia is 0.68%. If there are surgical complications, such as capsule rupture and vitreous loss, the study by Onal et al.39 suggests that the rate of RRD multiplies by a factor of more than 4 and that of cystoid macular edema, by a factor of 2. Why does the RRD rate increase in myopic eyes having KPE lens extraction and implantation? Does the presence of an IOL make a difference? Can we deduce information from a study of phakic IOL (pIOL) implantation in myopic eyes? What are the mechanisms underlying the initiation of RRD? What is the timescale of RRD after lens extraction? What is the effect of an Nd:YAG laser posterior capsulotomy on RRD? Is retinal prophylaxis of value in reducing the rate of RRD after myopic RLE and pIOL implantation? Finally, when RRD occurs, what is the likely outcome of surgical repair? Why does the RRD rate increase in myopic eyes having KPE and implantation? Large eyes have retinal stretching, with a consequential higher incidence of retinal degeneration that may lead to hole formation and subsequent RRD. Furthermore, vitreoretinal pathology leading to anomalous adhesions between the vitreous and retina lead to retinal tears when a posterior vitreous detachment (PVD) occurs, a common postoperative phenomenon after lens extraction and, possibly, pIOL implantation. Ramos et al.40 mention the widely held belief that volumetric changes in eyes having the crystalline lens removed induce circumstances that excite vitreoretinal pathology. The volume of the eye obviously varies according to its diameter. As the crystalline lens is removed, the degenerate/stretched vitreous expands to fill the void; however, prophylactic therapy is limited because most RRDs are due to retinal tears that develop in areas of the retina that appear normal before vitreous detachment. Does the presence of an IOL make a difference? Tosi et al.19 report a series of myopic lens extractions without IOL replacement with an RRD rate of 1.3%, which is lower than the mean RRD rate of 2.2% of the entire group 2–34; however, only 73 eyes were studied. It could be argued that an IOL may provide more substantial support for the anterior vitreous face and therefore reduce the incidence of PVD, but as the rate of RRD is less than the mean rate in eyes with an IOL, the argument cannot be sustained. Can we deduce information from a study of pIOL implantation in myopic eyes? Martínez-Castillo et al.24 discuss the mechanisms underlying the initiation of RRD. The data suggest that merely entering a myopic eye surgically may induce PVD with retinal tear consequences. The data on cause and outcome make interesting comparison with myopic RLE and myopic cataract extraction data, with which there are many similarities. In the study by Martínez-Castillo et al., the incidence of RRD after posterior chamber pIOL implantation was 2.07%; the mean patient age was 32.9 years (range 23 to 46 years); 9 patients (60%) had bilateral posterior chamber pIOL implantation; primary RRD developed in 16 eyes of 15 patients; prophylactic laser photocoagulation was performed in 3 eyes of 3 patients (18.75%); the mean preoperative spherical equivalent (SE) was −17.3 D ± 2.47 (SD) (range −13.75 to −22.00 D); RRDs occurred from 1 to 70 months after PC pIOL implantation (mean 29.12 months); each of 11 RRDs (68.75%) had 1 causative break; 14 breaks (60.86%) were horseshoe tears and 9 (39.14%), atrophic holes; scleral buckling was performed in 10 eyes (62.5%); pars plana vitrectomy alone was performed in 5 cases (31.25%) with posterior breaks; the initial reattachment rate was 90.9% and the final reattachment rate, 100%; the mean postoperative best spectacle-corrected visual acuity was 20/28 (decimal fraction 0.72 ± 0.25); and the mean follow-up after retinal detachment surgery was 35.25 ± 17.29 months (range 12 to 67 months). What is the timescale of RRD after lens extraction? The data are inconclusive. Norregaard et al.41 suggest that about 60% of detachments following extracapsular cataract extraction (ECCE) and IOL implantation occur within 1 year with approximately one quarter occurring 3 years or later, which is consistent with previous reports that indicate up to 75% of detachments occur within 1 year of surgery. Ranta et al.42 note that the mean time for an RRD to occur postoperatively is 39 months. What is the effect of Nd:YAG laser posterior capsulotomy on RRD? Tielsch et al.43 address the odds ratio for RRD after cataract surgery in general. “Conditional logistic regression models showed that a number of factors were associated independently with an excess risk for RRD after cataract surgery. These included Nd:YAG laser capsulotomy (odds ratio [OR] = 3.8; 95% confidence interval [CI], 2.4-5.9), a history of retinal detachment (OR = 2.7; 95% CI, 1.2-6.1), a history of lattice degeneration (OR = 6.6; 95% CI, 1.6-27.1), axial length (OR = 1.21/mm; 95% CI, 1.03-1.43), refractive error (OR = 0.92/diopter; 95% CI, 0.88-0.95), and a history of ocular trauma after cataract surgery (OR = 6.1; 95% CI, 4.3-28.2).” Other authors10,15,27 are more reticent about the effect of Nd:YAG capsulotomy on RRD rates. Koch et al.44 conducted a retrospective analysis of Q-switched Nd:YAG laser capsulotomies performed in 122 eyes between April 1984 and June 1987. Retinal complications occurred in 3 (2.5%) of 121 eyes followed for 1 year and in 2 (3.6%) of 55 eyes followed for 2 years. Four eyes developed RRD, and 1 developed an acute symptomatic retinal tear that correlated with axial myopia, preexisting vitreoretinal disease, male sex, younger age, vitreous prolapse into the anterior chamber, and spontaneous extension of the capsulotomy. If there is an increased risk for RRD after Nd:YAG capsulotomy in myopic pseudophakic eyes, the literature shows significant variation in the RRD rate and time after capsulotomy.3–33 The methodology of Nd:YAG capsulotomy may be a factor in the variance. The energy used during treatment, the diameter of the capsulotomy, and previous preoperative and postoperative retinal scrutiny may play a part; however, this degree of detail is not extractable from the literature.40,43 Is retinal prophylaxis of value in reducing the rate of RRD after myopic RLE and pIOL implantation? Asymptomatic retinal breaks occur in approximately 7% of patients older than 40 years, lattice degeneration occurs in approximately 8% of the general population, and 30% of RRDs have lattice-related tears. A decision to treat vitreoretinal lesions that are relatively unlikely to cause an RRD must also consider the risks that treatment may be unnecessary, ineffective, or even harmful.45 Martínez-Castillo et al.24 performed prophylactic retinal therapy in their pIOL implantation series. If PVD is the major initiating event, implying that retinal pathology discovered preoperatively may be limited, retinal prophylaxis should have marginal effect on the incidence of RRD. The literature supports this view in terms of preexisting identifiable retinal pathology. Colin et al.'s studies32–34 of RRD in myopic eyes was based on a very small sample of which 4 RRDs (3 patients) occurred some years after cataract extraction using methods not comparable to today's surgical procedure. They demonstrate that prophylactic treatment seemingly had little value in preventing detachment. Particular risk factors illustrated in the studies were myopia greater than 10.0 D and the passage of time in a pseudophakic myopic eye despite prophylactic retinal treatment. If a conclusion were to be reached on the basis of these findings, it would be that regular sequential monitoring of myopic pseudophakic eyes is required at least until a PVD occurs and the treatment should be considered if retinal pathology that could lead to an RRD is detected. Do the data warrant that degree of follow-up observation? Sharma et al.46 studied 64 patients who had an RRD in 1 eye but were phakic in the fellow eye. During a mean follow-up of 57.4 months, 5 (7.8%) fellow eyes developed an RD. In addition to these 5 eyes with a phakic RD, 10 originally phakic fellow eyes had cataract surgery. Of these, 1 (10%) had an RRD. Thus, Sharma et al. conclude that fellow eyes of patients with a RRD have a significant risk for RD even if they do not have cataract surgery. However, this does not mean that signs of impending RRD would be discernible or that prophylactic therapy is admissible. In terms of myopic eyes, this study confirms a need to carefully evaluate vitreoretinal signs in myopic phakic and pseudophakic eyes. More circumstantial evidence of the effect of lens extraction on the eye's internal structures is offered by Grand,47 who studied the risk for a new retinal break or detachment following cataract surgery in eyes that had had successful repair of a phakic retinal break or detachment. In a 10-year study, he found that cataract surgery was associated with a 4.6% incidence of new breaks or detachment. Cataract surgery, ie, lens extraction, appears to be an independent risk factor for retinal tears or detachments. It follows that a dilated retinal examination following cataract surgery is advisable in patients who had repair of a phakic retinal tear or detachment and more advisable in pseudophakic myopic eyes without prior detachment or retinal tear. This study seems to confirm the theory that expanding the internal volume of the eye by lens extraction and the internal dynamic changes that take place during the extraction process may be an important precursor of retinal breaks and subsequent RRD. Finally, when RRD does occur, what is the likely outcome of surgical repair? In considering the functional and anatomical outcome of RRD surgery in pseudophakic eyes and myopic eyes in particular, Ranta et al.42 report the outcome in 138 eyes treated by uneventful ECCE that was followed by RRD. The Nd:YAG capsulotomy rate was 35%. Seventy-four percent of eyes achieved successful retinal repair following 1 procedure. Overall, 91% achieved long-term retinal attachment; ie, there was a 9% failure rate or 1 in 10 eyes. Many had some reduction of best corrected visual acuity. Because of life-long risks for RRD in myopic eyes, a large diameter IOL and a wide continuous curvilinear capsulorhexis may be advisable to facilitate postoperative retinal scrutiny. In a study of 114 cases of RRD after phacoemulsification, Haddad et al.48 indicated that once RRD occurred, there was no statistically significant correlation between the final visual outcome and KPE intraoperative complications including posterior capsule rupture, vitreous loss, and posteriorly dislocated lens fragments. Christensen and Villumsen49 compared preoperative and postoperative findings in 120 pseudophakic patients and 280 phakic patients who had RRD surgery during a 4-year period. An identical scleral buckling procedure was used for primary surgery in both groups. Phacoemulsification cataract surgery was performed in 67.5% of the pseudophakic eyes. The mean follow-up was 13.5 months. Pseudophakic patients with RRDs presented with significantly worse preoperative visual acuity than phakic patients due to a higher frequency of total RRDs and macula-off RRDs. Retinal breaks were found significantly less frequently and reoperations were performed with a higher frequency in the pseudophakic patients than in the phakic patients. The overall anatomic reattachment rate was 94% and 96%, respectively, and the visual outcome was also identical, with a visual acuity better than 0.4 in about 60% of patients. Christensen and Villumsen conclude that the anatomical and visual prognosis of pseudophakic detachments are identical to those of phakic detachments. Risk management of RRD, particularly in relation to lens extraction and IOL implantation, is especially pertinent today when KPE through small corneal incisions with varied opportunity for IOL implantation with varied properties has and will continue to increase RLE and pIOL implantation in a target population that is different in age from the general cataract population. As noted, RLE and posterior chamber pIOL bring joyous benefits to most patients, but these patients have to be apprised of the inherent risks of having these types of surgery in their large eyes." @default.
• W2076420801 created "2016-06-24" @default.
• W2076420801 creator A5046587458 @default.
• W2076420801 date "2006-05-01" @default.
• W2076420801 modified "2023-10-14" @default.
• W2076420801 title "Risk management for rhegmatogenous retinal detachment following refractive lens exchange and phakic IOL implantation in myopic eyes" @default.
• W2076420801 cites W1602378423 @default.
• W2076420801 cites W1603904009 @default.
• W2076420801 cites W185079192 @default.
• W2076420801 cites W1941128778 @default.
• W2076420801 cites W1968343541 @default.
• W2076420801 cites W1978669693 @default.
• W2076420801 cites W1991357398 @default.
• W2076420801 cites W1996368472 @default.
• W2076420801 cites W2024947110 @default.
• W2076420801 cites W2029952992 @default.
• W2076420801 cites W2033636136 @default.
• W2076420801 cites W2041395029 @default.
• W2076420801 cites W2050029797 @default.
• W2076420801 cites W2054075673 @default.
• W2076420801 cites W2056057983 @default.
• W2076420801 cites W2058434163 @default.
• W2076420801 cites W2059862911 @default.
• W2076420801 cites W2060584316 @default.
• W2076420801 cites W2061688131 @default.
• W2076420801 cites W2068843093 @default.
• W2076420801 cites W2074440188 @default.
• W2076420801 cites W2077387717 @default.
• W2076420801 cites W2080660237 @default.
• W2076420801 cites W2081790449 @default.
• W2076420801 cites W2081886842 @default.
• W2076420801 cites W2089447198 @default.
• W2076420801 cites W2107874799 @default.
• W2076420801 cites W2110027830 @default.
• W2076420801 cites W2126693811 @default.
• W2076420801 cites W2147034608 @default.
• W2076420801 cites W2162866907 @default.
• W2076420801 cites W2191410972 @default.
• W2076420801 cites W2225483998 @default.
• W2076420801 cites W41147525 @default.
• W2076420801 cites W75486489 @default.
• W2076420801 doi "https://doi.org/10.1016/j.jcrs.2006.03.012" @default.
• W2076420801 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/16765766" @default.
• W2076420801 hasPublicationYear "2006" @default.
• W2076420801 type Work @default.
• W2076420801 sameAs 2076420801 @default.
• W2076420801 citedByCount "17" @default.
• W2076420801 countsByYear W20764208012012 @default.
• W2076420801 countsByYear W20764208012013 @default.
• W2076420801 countsByYear W20764208012014 @default.
• W2076420801 countsByYear W20764208012016 @default.
• W2076420801 countsByYear W20764208012019 @default.
• W2076420801 countsByYear W20764208012020 @default.
• W2076420801 countsByYear W20764208012021 @default.
• W2076420801 countsByYear W20764208012023 @default.
• W2076420801 crossrefType "journal-article" @default.
• W2076420801 hasAuthorship W2076420801A5046587458 @default.
• W2076420801 hasConcept C118487528 @default.
• W2076420801 hasConcept C119767625 @default.
• W2076420801 hasConcept C2776148792 @default.
• W2076420801 hasConcept C2776660847 @default.
• W2076420801 hasConcept C2780428090 @default.
• W2076420801 hasConcept C2780827179 @default.
• W2076420801 hasConcept C2781135284 @default.
• W2076420801 hasConcept C71924100 @default.
• W2076420801 hasConceptScore W2076420801C118487528 @default.
• W2076420801 hasConceptScore W2076420801C119767625 @default.
• W2076420801 hasConceptScore W2076420801C2776148792 @default.
• W2076420801 hasConceptScore W2076420801C2776660847 @default.
• W2076420801 hasConceptScore W2076420801C2780428090 @default.
• W2076420801 hasConceptScore W2076420801C2780827179 @default.
• W2076420801 hasConceptScore W2076420801C2781135284 @default.
• W2076420801 hasConceptScore W2076420801C71924100 @default.
• W2076420801 hasIssue "5" @default.
• W2076420801 hasLocation W20764208011 @default.
• W2076420801 hasLocation W20764208012 @default.
• W2076420801 hasOpenAccess W2076420801 @default.
• W2076420801 hasPrimaryLocation W20764208011 @default.
• W2076420801 hasRelatedWork W2000537818 @default.
• W2076420801 hasRelatedWork W2137711470 @default.
• W2076420801 hasRelatedWork W2406636347 @default.
• W2076420801 hasRelatedWork W2411161282 @default.
• W2076420801 hasRelatedWork W2414117791 @default.
• W2076420801 hasRelatedWork W2469882884 @default.
• W2076420801 hasRelatedWork W2891524990 @default.
• W2076420801 hasRelatedWork W3116156768 @default.
• W2076420801 hasRelatedWork W4327954448 @default.
• W2076420801 hasRelatedWork W4380368269 @default.
• W2076420801 hasVolume "32" @default.
• W2076420801 isParatext "false" @default.
• W2076420801 isRetracted "false" @default.
• W2076420801 magId "2076420801" @default.
• W2076420801 workType "article" @default.