Rhegmatogenous retinal detachment in phakic eyes after posterior chamber phakic intraocular lens implantation for severe myopia

Abstract

Objective: To report the clinical presentation, surgical management, and outcomes of rhegmatogenous retinal detachment (RRD) in patients with severe myopia corrected by posterior chamber phakic (PCP) intraocular lens (IOL) implantation.

Design: Retrospective, noncomparative, interventional case series.

Participants: Sixteen eyes of 15 patients in whom retinal detachment developed after PCP IOL implantation.

Methods: The 16 eyes with retinal detachment after PCP IOL implantation underwent scleral buckling and pars plana vitrectomy.

Main outcome measures: Uncorrected visual acuity, refraction, best spectacle-corrected visual acuity (BSCVA), time between refractive procedure and RRD, vitreoretinal findings, and anatomic reattachment rate.

Results: The incidence of RRD after PCP IOL implantation was 2.07%. Mean patient age was 32.9 years (range, 23-46). Nine patients underwent bilateral PCP IOL implantation (60%). Primary RRD developed in 16 eyes of 15 patients. Prophylactic laser photocoagulation was performed in 3 eyes of 3 patients (18.75%). Mean preoperative spherical equivalent (SE) was -17.3+/-2.47 diopters (D) (range, -13.75 D to -22 D). Rhegmatogenous retinal detachment occurred from 1 to 70 months after PCP IOL implantation (mean, 29.12 months). Each of 11 RRDs (68.75%) had 1 causative break. Fourteen breaks (60.86%) were horseshoe tears and 9 (39.14%) were 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. Initial reattachment rate was 90.9%. Final retinal reattachment was 100%. Mean postoperative BSCVA was 20/28 (decimal fraction, 0.72+/-0.25). Mean follow-up after retinal detachment surgery was 35.25+/-17.29 months (range, 12-67 months).

Conclusions: Rhegmatogenous retinal detachment after PCP IOL implantation is rare. Case-control studies are warranted to determine whether this surgical procedure increases the risk of retinal detachment in these patients. The characteristics of RRD do not differ from the natural history of retinal detachment. Surgical management of RRD was successful in restoring vision in our patients. This article contains additional online-only material available at .