Documenta Ophthaimologica 48,2: 267-271, 1979

RETINAL DETACHMENT AND PSEUDOPHAKOS

D.A.E. MERTENS, R. ZIVOJNOVIC & G.S. BAARSMA

(Rotterdam)

Keywords: Intraocular lenses, Retinal detachment, Panfunduskop, Pseudophakos

ABSTRACT

With the increasing number of intraocular lensimplants the retina surgeon is more often confronted with retinal detachment after lensimplantation. The treatment of pseudophakic retinal detachment is mostly a problem of examination. The Pan- funduskop of Schlegel is a very valuable aid and permits detection of most breaks situated anterior or on the equator. The article presents the results of 37 operated eyes.

MATERIALS AND METHODS

The material consisted of 36 patients, totally 37 eyes with retinal detach-

ment and pseudophakos, treated between August 1975 and April 1979.

Most patients were referred to us, a few came from our own clinic. The

examination comprised: evaluation of the anterior segment (position of

implant, available clear pupillary area), examination of the fundus with bin-

ocular ophthalmoscope, three-mirror lens of Goldmann and Panfunduskop of Schlegel. Surgical treatment consisted of an encercling silicone band in all

cases, if necessary com/91eted by one or more r~dial sitastic suprascteral

implants; only once a circular silastic element was used. Cryotherapy under

direct visual control was used on the tears and over 360 degrees in all cases.

Release of subretinal fluid was done in most cases.

RESULTS

Sex distribution and age: of the 36 patients 29 were male, 7 were female.

Age varied from 14 to 85 years with an average of 61,2 years. Time interval

between implantation and detachment varied from 6 weeks to 9 years, with

267

Fig. 1. Anterior segment with iridocapsular lens (right eye patient 36).

an average of 2,3 years; however, 16 eyes (43%) developed the detachment

in the first year after the implantation. Indication for implantation was

traumatic cataract in 2 eyes, presenile cataract (under 50 years of age) in 5 eyes and senile cataract in the remaining 30 eyes. Extraction was intra-

capsular in 17 eyes, extracapsular in 20 eyes (including the 2 traumatic

cases). The lensimplants were Binkhorst irisclip and iridocapsular lenses and

Worst Medallion or iris-fixated lenses, Twelve patients had a bilateral intra- ocular lens. Examination was very difficult and time-consuming as previously

stated by Jungschafer (1977). Examination with the Panfunduskop lens adds a new perspective; it gives a bright image of the fundus and makes it possible to detect in most cases breaks lying anterior or on the equator.

Figure 1 shows the anterior segment of a patient with iridocapsular lens

and figure 2 shows a picture of the fundus of the same eye taken with the

Panfunduskop: a shallow retinal detachment of both inferior quadrants is

visible. Figure 3 shows the postoperative state 2 weeks after operation with

reattached retina after encercling procedure and radial silastic buckle in five

o'clock position. The type of detachment was quite similar to the ordinary aphakic detach-

ment; it often started in the superior quadrants and had a tendency to become total in a short period of time. Breaks were mostly of the small

268

Table 1. Postoperative visual acuity.

1,0 - 0,9: 2 cases 0,8 - 0,5: 8 cases 0,4 - 0,25: 7 cases 0,15 - 0,1: 9 cases 5/60: 6 cases H.M., L.P. or less: 5 cases

horseshoe type; in 10 eyes no breaks were found. Of the 37 eyes t rea ted

the ret ina rea t tached in 29 after one opera t ion , in 3 more after two opera-

t ions: totall ing 32 rea t tached ret inae (89% success). The visual acuity

a t ta ined is shown in table 1. In five eyes t r ea tmen t failed. Four eyes devel-

Fig. 2. Fundusphotograph of same patient. Shallow retinal detachment of both inferior quadrants; small horseshoe tear in five o'clock position not visible on photograph (Panfunduskop).

269

oped massive periretinal proliferation (MPP) and in one patient treatment

was abandoned after 3 operations because of high age. Complications. Two

patients needed a preoperative discission of a very dense aftercataract; in

both cases the final result was poor. During the operations complications

did not occur. One patient developed a choroidal hemorrhage 4 days after operation and ended with a MPP. 3 patients developed a partial dislocation

of the implant within 2 months after the operation, which needed surgical

reposition in one case. Examination of the fellow eye revealed vitreoretinal degenerations in 8 patients; however, it has to be stated that the examina-

tion of the fellow eye was often incomplete and was hindered by cataract

or lensimplant. Two patients had a bilateral ret inal detachment: of them

one had a bilateral intraocular implant for presenile cataract and was treated

Fig. 3. Fundusphotograph of same patient 2 weeks after encercling procedure and radial silastic buckle in five o'clock position. Arrow points at horseshoe tear.

270

with success; the other had a long standing total detachment with macular

hole in an aphakic eye and was considered untreatable, the eye with the

implant and detachment was treated with success. The detected vitreoretinal degenerations were treated with Argon laser coagulation in 7 eyes and with

cryotherapy in one eye.

CONCLUSION

More and more the retina surgeon is confronted with retinal detachment

after intraocular implant. Diagnostic procedures are very difficult and time-

consuming. The Panfunduskop of Schlegel is a very valuable aid in detecting

retinal breaks and thus contributed in successful repair. The results of treat- ment are satisfactory (89% success) if all breaks can be treated. Examination

of the fellow eye is very important and reveals often vitreoretinal degenera-

tions which need treatment. Examination of the retinal periphery of eyes

where an intraocular lens is planned is a must and caution must be exercised in implanting lenses in presenile cataract because of the frequent presence

of vitreoretinal degenerations.

REFERENCES

Jaffe, N.S., Galin, M.A., Hirschmann, H. & Clayman, H.M. Pseudophakos. Saint Louis, Mosby, 1978.

Jungschafer, O.H. Retinal detachments after intraocular lens implants.Arch. Ophthal. 95:1203-1204 (1977).

Schlegel, H.J. Das Panfunduskop in Diagnostik und Therapie peripheren Netzhauter- krankungen. BerichteD.O.G. 74:75-78 (1977).

Authors' address: Department of Ophthalmology Erasmus University Eye Hospital Schiedamse Vest 180 3011 BH Rotterdam The Netherlands

271