Insights into retinal detachment after phakic intraocular lens implantation

Abstract

We read with interest the study by Lapeyre et al.1 Rhegmatogenous retinal detachments (RDs) have been reported after both anterior chamber (AC) and posterior chamber (PC) phakic intraocular lens (pIOL) implantation.2,3 Patients with moderate and high myopia are at increased risk for RD, in particular patients with axial lengths greater than 30.24 mm.2,4 The incidence of RD in eyes with a AC pIOL has been estimated to be 2.9% to 7.1%, with an average interval between the surgery and RD of 24.4 months ± 24.4 (SD).2 Overall, RD might be a natural course in highly myopic patients and the risk from pIOL implantation small. Retinal screening for predisposing conditions should be performed for every patient before and after refractive surgery. However, there are cases, as documented by Lapeyre et al.,1 of direct pIOL-related posterior vitreous detachment leading to formation of new retinal breaks. We previously reported a case of a giant retinal tear with RD 2 weeks after PC pIOL implantation, which was also likely the result acute posterior vitreous detachment.5 Moreover, it has been suggested that patients treated for precursor lesions by photocoagulation before refractive surgery can develop new lesions in the untreated periphery, leading to detachments. A 30-year-old man presented to us with a giant retinal tear and a total RD 3 months after AC pIOL implantation. Our patient had refractive surgery at another facility and because no laser spots were visible, we assumed there was no break or predisposing lesion before AC pIOL implantation. The RD settled with good recovery of vision after 25-gauge vitreoretinal surgery with silicone oil injection; the AC pIOL was left in situ (Figure 1). A causal association between AC pIOL implantation and the giant retinal tear in our case seemed apparent from the absence of predisposing factors preoperatively, the presence of temporal relationship (3 months between surgery and giant retinal tear), and the absence of a family history of RD.Figure 1: Ultra-wide-field pseudo-color photograph of the posterior segment showing a giant retinal tear with retinal detachment in an eye with an anterior chamber phakic intraocular lens in situ.Thus, we would like to reemphasize the importance of peripheral fundus screening for predisposing lesions of RD before and after refractive surgery. Given that pIOL-induced edge-related aberrations have been reported, it would have been further enlightening had Lapeyre et al.1 included a posterior segment clinical photograph of the RD, described whether special precautions were taken, and reported difficulties faced during the retinal procedure.