Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Postoperative Retinal Detachment Follow-up

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 11, 2016
 

Further Outpatient Care

According to the surgeon's discretion, an intraocular gas bubble may have been used in the repair of the RRD. If this is the case, the patient will have to adopt a certain head position for several weeks.

Next

Further Inpatient Care

Most vitreoretinal procedures are performed as ambulatory outpatient procedures.

Previous
Next

Inpatient & Outpatient Medications

Following vitreoretinal surgery, the patient is usually prescribed a topical prophylactic antibiotic, a topical corticosteroid (eg, prednisolone acetate), and a cycloplegic (eg, atropine 1%). The intraocular pressure is monitored during the postoperative period and treated as necessary with beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, and prostaglandin analogs.

Previous
Next

Deterrence/Prevention

It is good clinical practice that the general ophthalmologist dilates the pupil and examines the peripheral retina prior to cataract surgery. If abnormalities are found, the patient should be referred to a vitreoretinal specialist for further management.

If a patient has risk factors for retinal detachment (eg, myopia, fellow eye retinal detachment, family history), a silicone IOL should not be placed. Instead, a foldable acrylic IOL is a better option.

Previous
Next

Complications

PVR is the most common cause of failure of surgical reattachment surgery.

Elevated intraocular pressure is common after either vitrectomy with intraocular tamponade or scleral buckling procedures. Most cases respond to topical medications. Very seldom does one have to release the buckle or withdraw gas from the vitreous cavity.

Endophthalmitis following vitrectomy is rare. A scleral buckle may become infected and may need to be removed.

Previous
Next

Prognosis

Most series indicate that up to 95% of cases are anatomical successes. Of these cases, as many as 50% obtain a visual acuity of 20/50 or better.[1, 14]

In a retrospective longitudinal cohort analysis of 9216 Medicare beneficiaries diagnosed with a rhegmatogenous retinal detachment between 1991-2007, patients who had undergone primary pneumatic retinopexy were 3 times more likely to receive a second retinal detachment operation compared to scleral buckling or pars plana vitrectomy. Risk of additional retinal detachment surgery did not differ significantly between scleral buckling and pars plana vitrectomy. Patients who had a pars plana vitrectomy were 2 times more likely to suffer adverse events as compared with those who had scleral buckling.[30]

Previous
Next

Patient Education

Patients should be educated regarding the symptoms, namely floaters and photopsia, of an acute PVD. Patients should be instructed to seek immediate attention if these symptoms occur.

Previous
 
Contributor Information and Disclosures
Author

Lihteh Wu, MD Asociados de Macula Vitreo y Retina de Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical; Heidelberg Engineering.

Coauthor(s)

Dhariana Acón, MD Ophthalmologist, Caja Costarricense Seguro Social, Hospital de Guapiles, Costa Rica

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, Vitreo-Retinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

References
  1. Lois N, Wong D. Pseudophakic retinal detachment. Surv Ophthalmol. 2003 Sep-Oct. 48(5):467-87. [Medline].

  2. Hermann MM, Kirchhof B, Fauser S. Temporal occurrence of retinal detachments after cataract surgery. Acta Ophthalmol. 2012 Dec. 90(8):e594-6. [Medline].

  3. Bjerrum SS, Mikkelsen KL, La Cour M. Risk of pseudophakic retinal detachment in 202,226 patients using the fellow nonoperated eye as reference. Ophthalmology. 2013 Dec. 120(12):2573-9. [Medline].

  4. Forstot SL, Binder PS, Fitzgerald C, Kaufman HE. The incidence of retinal detachment after penetrating keratoplasty. Am J Ophthalmol. 1975 Jul. 80(1):102-5. [Medline].

  5. Musch DC, Meyer RF, Sugar A, Vine AK. Retinal detachment following penetrating keratoplasty. Arch Ophthalmol. 1986 Nov. 104(11):1617-20. [Medline].

  6. Aiello LP, Javitt JC, Canner JK. National outcomes of penetrating keratoplasty. Risks of endophthalmitis and retinal detachment. Arch Ophthalmol. 1993 Apr. 111(4):509-13. [Medline].

  7. Michels RG. Vitrectomy for macular pucker. Ophthalmology. 1984 Nov. 91(11):1384-8. [Medline].

  8. de Bustros S, Thompson JT, Michels RG, Rice TA, Glaser BM. Vitrectomy for idiopathic epiretinal membranes causing macular pucker. Br J Ophthalmol. 1988 Sep. 72(9):692-5. [Medline].

  9. de Bustros S, Rice TA, Michels RG, Thompson JT, Marcus S, Glaser BM. Vitrectomy for macular pucker. Use after treatment of retinal tears or retinal detachment. Arch Ophthalmol. 1988 Jun. 106(6):758-60. [Medline].

  10. Rice TA, De Bustros S, Michels RG, Thompson JT, Debanne SM, Rowland DY. Prognostic factors in vitrectomy for epiretinal membranes of the macula. Ophthalmology. 1986 May. 93(5):602-10. [Medline].

  11. Thompson JT, de Bustros S, Michels RG, Rice TA. Results and prognostic factors in vitrectomy for diabetic vitreous hemorrhage. Arch Ophthalmol. 1987 Feb. 105(2):191-5. [Medline].

  12. Noel LP, Bloom JN, Clarke WN, Bawazeer A. Retinal perforation in strabismus surgery. J Pediatr Ophthalmol Strabismus. 1997 Mar-Apr. 34(2):115-7. [Medline].

  13. Sheu SJ, Ger LP, Chen JF. Male sex as a risk factor for pseudophakic retinal detachment after cataract extraction in Taiwanese adults. Ophthalmology. 2007 Oct. 114(10):1898-903. [Medline].

  14. Ti SE, Yang YN, Lang SS, Chee SP. A 5-year audit of cataract surgery outcomes after posterior capsule rupture and risk factors affecting visual acuity. Am J Ophthalmol. 2014 Jan. 157(1):180-185.e1. [Medline].

  15. Duignan ES, Ní Dhubhghaill S, Malone C, Power W. Long-term visual acuity, retention and complications observed with the type-I and type-II Boston keratoprostheses in an Irish population. Br J Ophthalmol. 2015 Dec 1. [Medline].

  16. Awad AH, Mullaney PB, Al-Hazmi A, et al. Recognized globe perforation during strabismus surgery: incidence, risk factors, and sequelae. J AAPOS. 2000 Jun. 4(3):150-3. [Medline].

  17. Krishnan R, Tossounis C, Fung Yang Y. 20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes. Eye (Lond). 2013 Jan. 27(1):72-7. [Medline].

  18. Mendrinos E, Dang-Burgener NP, Stangos AN, Sommerhalder J, Pournaras CJ. Primary vitrectomy without scleral buckling for pseudophakic rhegmatogenous retinal detachment. Am J Ophthalmol. 2008 Jun. 145(6):1063-1070. [Medline].

  19. Brazitikos PD, Androudi S, Christen WG, Stangos NT. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial. Retina. 2005 Dec. 25(8):957-64. [Medline].

  20. Heimann H. [Primary 25- and 23-gauge vitrectomy in the treatment of rhegmatogenous retinal detachment--advancement of surgical technique or erroneous trend?]. Klin Monbl Augenheilkd. 2008 Nov. 225(11):947-56. [Medline].

  21. Arya AV, Emerson JW, Engelbert M, Hagedorn CL, Adelman RA. Surgical management of pseudophakic retinal detachments: a meta-analysis. Ophthalmology. 2006 Oct. 113(10):1724-33. [Medline].

  22. Fujii GY, De Juan E Jr, Humayun MS, Chang TS, Pieramici DJ, Barnes A. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002 Oct. 109(10):1814-20. [Medline].

  23. Fine HF, Iranmanesh R, Iturralde D, Spaide RF. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology. 2007 Jun. 114(6):1197-200. [Medline].

  24. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005 Feb-Mar. 25(2):208-11. [Medline].

  25. Acar N, Kapran Z, Altan T, Unver YB, Yurtsever S, Kucuksumer Y. Primary 25-gauge sutureless vitrectomy with oblique sclerotomies in pseudophakic retinal detachment. Retina. 2008 Oct. 28(8):1068-74. [Medline].

  26. Horozoglu F, Yanyali A, Celik E, Aytug B, Nohutcu AF. Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment. Indian J Ophthalmol. 2007 Sep-Oct. 55(5):337-40.

  27. Stangos AN, Petropoulos IK, Brozou CG, Kapetanios AD, Whatham A, Pournaras CJ. Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment. Am J Ophthalmol. 2004 Dec. 138(6):952-8. [Medline].

  28. Weichel ED, Martidis A, Fineman MS, McNamara JA, Park CH, Vander JF. Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology. 2006 Nov. 113(11):2033-40. [Medline].

  29. Kulkarni KM, Roth DB, Prenner JL. Current visual and anatomic outcomes of pneumatic retinopexy. Retina. 2007 Oct. 27(8):1065-70. [Medline].

  30. Day S, Grossman DS, Mruthyunjaya P, Sloan FA, Lee PP. One-year outcomes after retinal detachment surgery among medicare beneficiaries. Am J Ophthalmol. 2010 Sep. 150(3):338-45. [Medline]. [Full Text].

  31. Akinci A, Batman C, Zilelioglu O. Cataract surgery in previously vitrectomized eyes. Int J Clin Pract. 2008 May. 62(5):770-5. [Medline].

  32. Ashrafzadeh MT, Schepens CL, Elzeneiny II, Moura R, Morse P, Kraushar MF. Aphakic and phakic retinal detachment. I. Preoperative findings. Arch Ophthalmol. 1973 Jun. 89(6):476-83. [Medline].

  33. Bartz-Schmidt KU, Kirchhof B, Heimann K. Primary vitrectomy for pseudophakic retinal detachment. Br J Ophthalmol. 1996 Apr. 80(4):346-9. [Medline]. [Full Text].

  34. Basmadjian G, Labelle P, Dumas J. Retinal detachment after strabismus surgery. Am J Ophthalmol. 1975 Feb. 79(2):305-9. [Medline].

  35. Berrod JP, Sautiere B, Rozot P, Raspiller A. Retinal detachment after cataract surgery. Int Ophthalmol. 1996-1997. 20(6):301-8. [Medline].

  36. Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments. Ophthalmology. 1999 Sep. 106(9):1811-5; discussion 1816. [Medline].

  37. Chrousos GA, Parks MM, O'Neill JF. Incidence of chronic glaucoma, retinal detachment and secondary membrane surgery in pediatric aphakic patients. Ophthalmology. 1984 Oct. 91(10):1238-41. [Medline].

  38. Coonan P, Fung WE, Webster RG Jr, Allen AW Jr, Abbott RL. The incidence of retinal detachment following extracapsular cataract extraction. A ten-year study. Ophthalmology. 1985 Aug. 92(8):1096-101. [Medline].

  39. Cousins S, Boniuk I, Okun E, et al. Pseudophakic retinal detachments in the presence of various IOL types. Ophthalmology. 1986 Sep. 93(9):1198-208. [Medline].

  40. Desai UR, Strassman IB. Combined pars plana vitrectomy and scleral buckling for pseudophakic and aphakic retinal detachments in which a break is not seen preoperatively. Ophthalmic Surg Lasers. 1997 Sep. 28(9):718-22. [Medline].

  41. Eaton AM, Jaffe GJ, McCuen BW 2nd, Mincey GJ. Condensation on the posterior surface of silicone intraocular lenses during fluid-air exchange. Ophthalmology. 1995 May. 102(5):733-6. [Medline].

  42. Fan DS, Lam DS, Li KK. Retinal complications after cataract extraction in patients with high myopia. Ophthalmology. 1999 Apr. 106(4):688-91; discussion 691-2. [Medline].

  43. Fritch CD. Risk of retinal detachment in myopic eyes after intraocular lens implantation: a 7 year study. J Cataract Refract Surg. 1998 Oct. 24(10):1357-60. [Medline].

  44. Fujii GY, De Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002 Oct. 109(10):1807-12; discussion 1813. [Medline].

  45. Girard P, Karpouzas I. Pseudophakic retinal detachment: anatomic and visual results. Graefes Arch Clin Exp Ophthalmol. 1995 Jun. 233(6):324-30. [Medline].

  46. Greven CM, Sanders RJ, Brown GC, et al. Pseudophakic retinal detachments. Anatomic and visual results. Ophthalmology. 1992 Feb. 99(2):257-62. [Medline].

  47. Hagler WS. Pseudophakic retinal detachment. Trans Am Ophthalmol Soc. 1982. 80:45-63. [Medline].

  48. Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. 1982 Feb. 100(2):289-92. [Medline].

  49. Halberstadt M, Chatterjee-Sanz N, Brandenberg L, Koerner-Stiefbold U, Koerner F, Garweg JG. Primary retinal reattachment surgery: anatomical and functional outcome in phakic and pseudophakic eyes. Eye (Lond). 2005 Aug. 19(8):891-8. [Medline].

  50. Ho PC, Tolentino FI. Pseudophakic retinal detachment. Surgical success rate with various types of IOLs. Ophthalmology. 1984 Jul. 91(7):847-52. [Medline].

  51. Ibarra MS, Hermel M, Prenner JL, Hassan TS. Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol. 2005 May. 139(5):831-6. [Medline].

  52. Inoue M, Shinoda K, Ishida S, et al. Intraocular lens implantation after atopic cataract surgery decreases incidence of postoperative retinal detachment. Ophthalmology. 2005 Oct. 112(10):1719-24. [Medline].

  53. Irvine AR. The pathogenesis of aphakic retinal detachment. Ophthalmic Surg. 1985 Feb. 16(2):101-7. [Medline].

  54. Jaffe GJ. Management of condensation on a foldable acrylic intraocular lens after vitrectomy and fluid-air exchange. Am J Ophthalmol. 1997 Nov. 124(5):692-3. [Medline].

  55. Jaffe NS, Clayman HM, Jaffe MS. Retinal detachment in myopic eyes after intracapsular and extracapsular cataract extraction. Am J Ophthalmol. 1984 Jan. 97(1):48-52. [Medline].

  56. Jahn CE, Richter J, Jahn AH, Kremer G, Kron M. Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification. J Cataract Refract Surg. 2003 May. 29(5):925-9. [Medline].

  57. Javitt JC, Street DA, Tielsch JM, et al. National outcomes of cataract extraction. Retinal detachment and endophthalmitis after outpatient cataract surgery. Cataract Patient Outcomes Research Team. Ophthalmology. 1994 Jan. 101(1):100-5; discussion 106. [Medline].

  58. Keech RV, Tongue AC, Scott WE. Complications after surgery for congenital and infantile cataracts. Am J Ophthalmol. 1989 Aug 15. 108(2):136-41. [Medline].

  59. Kroll AJ, Machemer R. Experimental retinal detachment and reattachment in the rhesus monkey. Electron microscopic comparison of rods and cones. Am J Ophthalmol. 1969 Jul. 68(1):58-77. [Medline].

  60. Machemer R, Kroll AJ. Experimental retinal detachment in the owl monkey. VII. Photoreceptor protein renewal in normal and detached retina. Am J Ophthalmol. 1971 Mar. 71(3):690-5. [Medline].

  61. McDonnell PJ, Patel A, Green WR. Comparison of intracapsular and extracapsular cataract surgery. Histopathologic study of eyes obtained postmortem. Ophthalmology. 1985 Sep. 92(9):1208-25. [Medline].

  62. McHugh D, Wong D, Chignell A, Leaver P, Cooling R. Pseudophakic retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1991. 229(6):521-5. [Medline].

  63. McPherson AR, O'Malley RE, Bravo J. Retinal detachment following late posterior capsulotomy. Am J Ophthalmol. 1983 May. 95(5):593-7. [Medline].

  64. Moore JK, Kitchens JW, Smiddy WE, Mavrofrides EC, Gregorio G. Retinal breaks observed during pars plana vitrectomy. Am J Ophthalmol. 2007 Jul. 144(1):32-36. [Medline].

  65. Noel LP. Retinal complications of strabismus surgery. Curr Opin Ophthalmol. 1998 Jun. 9(3):56-8. [Medline].

  66. Norton EWD. Retinal detachment in aphakia. Am J Ophthalmol. 1964 Jul. 58:111-24. [Medline].

  67. Ober RR, Wilkinson CP, Fiore JV Jr, Maggiano JM. Rhegmatogenous retinal detachment after neodymium-YAG laser capsulotomy in phakic and pseudophakic eyes. Am J Ophthalmol. 1986 Jan 15. 101(1):81-9. [Medline].

  68. Olsen G, Olson RJ. Update on a long-term, prospective study of capsulotomy and retinal detachment rates after cataract surgery. J Cataract Refract Surg. 2000 Jul. 26(7):1017-21. [Medline].

  69. Olsen GM, Olson RJ. Prospective study of cataract surgery, capsulotomy, and retinal detachment. J Cataract Refract Surg. 1995 Mar. 21(2):136-9. [Medline].

  70. Ranta P, Kivelä T. Retinal detachment in pseudophakic eyes with and without Nd:YAG laser posterior capsulotomy. Ophthalmology. 1998 Nov. 105(11):2127-33. [Medline].

  71. Ranta P, Tommila P, Immonen I, Summanen P, Kivela T. Retinal breaks before and after neodymium:YAG posterior capsulotomy. J Cataract Refract Surg. 2000 Aug. 26(8):1190-7. [Medline].

  72. Rowe JA, Erie JC, Baratz KH, et al. Retinal detachment in Olmsted County, Minnesota, 1976 through 1995. Ophthalmology. 1999 Jan. 106(1):154-9. [Medline].

  73. Schepens CL. Retinal detachment and aphakia. Arch Ophthalmol. 1951. 45:1.

  74. Slusher MM, Seaton AD. Loss of visibility caused by moisture condensation on the posterior surface of a silicone intraocular lens during fluid/gas exchange after posterior vitrectomy. Am J Ophthalmol. 1994 Nov 15. 118(5):667. [Medline].

  75. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Am J Ophthalmol. 2003 Feb. 135(2):183-7. [Medline].

  76. Smith PW, Stark WJ, Maumenee AE, et al. Retinal detachment after extracapsular cataract extraction with posterior chamber intraocular lens. Ophthalmology. 1987 May. 94(5):495-504. [Medline].

  77. Sternberg P Jr, Meredith TA, Stewart MA, Kaplan HJ. Retinal detachment in penetrating keratoplasty patients. Am J Ophthalmol. 1990 Feb 15. 109(2):148-52. [Medline].

  78. Tielsch JM, Legro MW, Cassard SD, et al. Risk factors for retinal detachment after cataract surgery. A population-based case-control study. Ophthalmology. 1996 Oct. 103(10):1537-45. [Medline].

  79. Wilkinson CP. Pseudophakic retinal detachments. Retina. 1985 Winter-Spring. 5(1):1-4. [Medline].

  80. Wimpissinger B, Binder S. Entry-site-related retinal detachment after pars plana vitrectomy. Acta Ophthalmol Scand. 2007 Nov. 85(7):782-5. [Medline].

  81. Yoshida A, Ogasawara H, Jalkh AE, Sanders RJ, McMeel JW, Schepens CL. Retinal detachment after cataract surgery. Predisposing factors. Ophthalmology. 1992 Mar. 99(3):453-9. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.