Retinal detachment after phakic intraocular lens implantation in severe myopic eyes

Abstract

To report the incidence, clinical presentation, and surgical outcomes of retinal detachment in highly myopic patients corrected by implantation of phakic intraocular lenses (PIOLs). This is a retrospective interventional non-comparative case series. A total of 530 highly myopic eyes that underwent PIOLs implantation were included in the study. All patients completed at least a 2-year follow-up after PIOL implantation. The incidence of retinal detachment (RD) and subsequent treatments were reviewed. The refractive errors, axial lengths, time between refractive surgery and RD detection, vitreoretinal findings, rate of retinal reattachment, and the pre- and postoperative best-corrected visual acuity (BCVA) were analyzed. The overall incidence of RD was 1.5% (eight eyes of seven patients) with a mean time between PIOL implantation and detachment of 23.63 ± 18.12months (range, 2days-51months). Mean spherical equivalent (SE) before PIOL implantation was -17.53 ± 3.86 diopters (D) (range, -11.5D to -23.5D). Six patients underwent bilateral PIOL implantation. Five eyes were implanted with anterior chamber PIOLs and the other three received posterior chamber PIOLs. A traumatic history was presented before RD detection in four cases. Horseshoe tears, atrophic holes, or giant retinal tears were found in four (50%), two (25%), and two (25%) eyes, respectively. Two eyes (25%) underwent scleral buckling surgery, five eyes (62.5%) underwent pars plana vitrectomy surgery, and one eye (12.5%) underwent both procedures. Anatomical retinal attachment was achieved after first RD surgery in seven eyes. Mean BCVA after PIOL implantation and before RD was 20/40 (decimal refraction, 0.51 ± 0.31) compared to that of 20/80 (decimal refraction, 0.26 ± 0.12) after the RD surgery. Mean follow-up after RD surgery was 20.63 ± 12.93months (range, 8-42months). The incidence of RD after PIOLs implantation is low. Its characteristics do not differ significantly from the natural history of RD in high myopic eyes. PIOL implantation for surgical correction of severe myopia does not seem to increase the risk of RD. Good visual prognosis can be obtained with early surgical intervention.