Pseudophakic retinal detachment: anatomic and visual results

Abstract

Our purpose was to report the anatomic and visual results of pseudophakic retinal detachment surgery in a large series of consecutive cases and to analyze the risk factors for anatomic and functional failure. This retrospective study covered 290 primary cases of idiopathic rhegmatogenous retinal detachment operated on by the same surgeon during an 8-year period. Data relating to 26 pre-, per-, and postoperative variables were studied. For the statistical analyses we used both Chi-square and stepwise logistic regression tests. Vitreous loss occurred in 56 cases (19.3%), and the retina detached more than 2 years after lens extraction in 108 cases (37.2%). Breaks could be identified in 249 cases (85.8%), and the macula was involved in 235 (81%). The overall reattachment rate was 85.2% (247/290), and a postoperative visual acuity of 0.5 D or more was attained in 49.6% of cases (144/290). We found no difference between phakoemulsification, extracapsular, intracapsular techniques or between anterior chamber, posterior chamber, iris-fixated lenses as regards anatomic and functional outcomes. Proliferative vitreoretinopathy (PVR) and photoreceptor dysfunction were the main causes of anatomic and functional failure respectively. We identified extensive detachment, preoperative choroidal detachment, intraoperative hemorrhage and surgery for PVR as predictors of anatomic failure, while preoperative inflammation, preoperative PVR of grade B or worse, and surgery for PVR were predictors of functional failure. In this series, anatomic and visual results of reattachment surgery were much more affected by detachment features and by PVR than by the techniques and complications of cataract surgery.