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Home , Myopia, Retinal detachment

Refractive Myopic patients requesting RLE should be fully informed of risks

Emanuel Rosen

Sean Henahan distinction in my view between about one per cent retinal detachment per population.We suggest choosing a large in exchange in and lens exchange in year. optic, which will facilitate retinal hyperopia, because of the size of the and Several studies indicate that or management in those patients.A large MYOPIC do run an increased risk of the risk of retinal detachment, which is RLE considerably increases the risk capsulorhexis and an intact posterior capsule rhegmatogenous retinal detachment virtually nonexistent in hyperopic eyes,” he of retinal detachment in myopes.A study of are also of course very desirable. following refractive lens exchange (RLE) noted. 1800 phacoemulsification/ cataract Postoperative peripheral retinal scrutiny compared to hyperopic eyes, a new review First of all, the rate of retinal detachment extraction procedures showed a rate of over a significant period is well worthwhile. I of the literature confirms.Therefore in the general population without surgery 1.17% over a 10-year follow-up period, 0.117 believe that the benefits are worth the risk informed consent becomes especially appears to be 0.0118%, or 12 eyes per per annum. Patients under the age of 50 had in most myopic patients, because this is a important in that patient population, 100,000 according to a recent a cumulative rate of more than five per cent life-changing experience,” Dr Rosen said. according to Emanuel Rosen MD, FRCSE, epidemiological study by PJ Polkinghorne per annum.The rate was much lower among Nonetheless, these studies emphasise that Manchester, UK. MD of the University of Auckland.That study those over 70 years of age.The median the surgeon must be very careful when “This topic is particularly pertinent showed that even in a general population interval from phaco to retinal detachment performing refractive lens exchange in because RLE as a refractive procedure is myopic eyes. It is a very good choice for overwhelmingly successful. It is a life- hyperopic eyes where risk is very low. It is changing procedure as well as a vision- “This topic is particularly pertinent because RLE as a essential to take the time to educate the changing procedure for our patients. myopic patient considering RLE because of However, both surgeons and patients must refractive procedure is overwhelmingly successful. It is a increased risk.The alternative is a phakic lens be aware of the risks. It is up to us to implant, but the question then is does phakic understand it and explain it to the patient, life-changing procedure as well as a vision-changing lens implantation increase the risk compared and let the patient make the final decision,” to unoperated eyes, he commented. Dr Rosen told a session of the 21st procedure for our patients” “When a myopic patient comes in Congress of the -Pacific Academy of between age 40 and 50 years, I suggest a . retinal detachment is more common in was 3.25 years. Complicated surgery phakic IOL instead of refractive lens Although RLE has become a popular myopes, particularly males under the age of increased the risk. However,YAG laser exchange, even though they lose procedure worldwide, studies regarding 60. Studies looking specifically at myopes in did not appear to increase the . If they are hyperopic than I retinal detachment risk are relatively rare. the general population suggest a 50-fold risk. wouldn’t hesitate to recommend lens Dr Rosen evaluated all studies conducted on increased rate of retinal detachment exchange which is much safer for them from the subject over the past 12 years. He compared to non-myopes. Additional risk factors identified a retinal perspective,” Dr Rosen told looked at studies that included cataract Dr Rosen considered 21 published EuroTimes. surgery as well as those limited to RLE. A study published this year in studies, noting that numerous variables Informed consent is critical for those While the studies showed wide variations, Ophthalmology by Stephen Tufts MD of including age range, axial length, follow-up myopes who do decide to undergo several risk factors emerge. Moorfields Eye Hospital looked at the risk and patient selection make any analysis refractive lens exchange. “Some of the risks apply to any eye for retinal detachment after . difficult.Those studies showed a cumulative “I tell myopes that the cumulative risk of surgery.This is a bilateral procedure that is That study indicated that the risk for retinal rate of retinal detachment in operated eyes retinal detachment is two to eight per cent, done simultaneously in some centres detachment increases by a factor of 20 when ranging from 0% to 8.1%. Phacoemulsification but even if they don’t have surgery they have including our own.We’re dealing with large a posterior capsule tear occurs. Zonular itself increases the risk tenfold.The larger, a risk of retinal detachment because that is eyes and increasing the space within the eye dehiscence, retinal detachment in the fellow longer, studies seem to agree on a rate of the nature of the myopic eye.We are honest by removing the natural lens.There is a eye, longer axial length and lattice with them that there is an increased risk. degeneration also Even if you can’t categorise the risk perfectly, increased the risk. In they should be aware of it. Informed consent that study 25% of is a difficult area.You can’t teach patients retinal detachments everything you know, but you can highlight occurred within three the key factors and make them aware that months of surgery, 50% “We know there are lifelong risks of retinal detachment in myopes. Refractive lens exchange increases the risk more than cataract extraction because of the youth of that population”

there are sight-threatening risks. If they do within 10 months, and get a retinal detachment and you haven’t 75% within 29 months. explained it, you are in breach of duty,” he “We know there are emphasised. lifelong risks of retinal Dr Rosen detailed his findings in an article in the detachment in myopes. Journal of Cataract & , ( Refractive lens May 2006,Vol. 32, Issue 5, Pages 697-701). exchange increases the risk more than cataract [email protected] extraction because of the youth of that

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