C
ORRESPONDENCE
Retinal Detachment in Phakic Eyes
With Anterior Chamber Intraocular
Lenses to Correct Severe Myopia
EDITOR:
THE AUTHORS OF “RETINAL DETACHMENT IN PHAKIC EYES
with anterior chamber intraocular lenses to correct severe
myopia” (Am J Ophthalmol 127:270 –275, March 1999) are
to be commended for reporting the results of a clinically
controlled study to investigate the rate of retinal detachment
after implantation of phakic anterior chamber intraocular
lenses (IOLs).
Dr Ruiz-Moreno and associates concluded: “The im-
plantation of a phakic anterior chamber intraocular lens as
a correcting procedure for severe myopia was followed by a
4.8% incidence of retinal detachment. Conventional
scleral surgery was successful in most cases, without causing
significant changes in the final best-corrected visual acuity
but inducing a further myopic refractive change.”
We believe that vitreoretinal surgery (including scleral
buckling) induces changes in corneal shape, thus damaging
the refractive surgeon’s results (Azar-Arevalo O, unpublished
data, 1998). We suggest that cryopexy, argon laser reti-
nopexy, pneumatic retinopexy, or primary vitrectomy with-
out a scleral band be performed when appropriate, because
these procedures tend not to change the shape or length of
the globe. Another option in the case of scleral buckling
procedures is to remove the exoplants early, as suggested by
Rodriguez and Camacho,
1
after ensuring that all breaks have
sealed and that no retinal detachment is present in the fundus.
Dr Ruiz-Moreno and associates also stated: “The high
incidence of retinal detachment in patients with predis-
posing lesions previously treated with laser photocoagula-
tion (14.28% vs 3.94% in the nontreated group; P Ͻ .001,
chi-square test) confirms previous reports about the doubt-
ful efficacy of this prophylactic treatment.”
We recently reported our results to determine the inci-
dence of vitreoretinal complications after laser in situ kera-
tomileusis (LASIK).
2
We found that 20 eyes (17 patients)
had vitreoretinal complications after LASIK (including 14
retinal detachments), for an incidence of 0.06% (20/29, 916
eyes). This number is much lower than the incidence of
retinal detachment in myopic patients in general (1% to
3%).
3
This finding is probably explained by the fact that our
refractive surgery patients undergo preoperative examinations
including a thorough dilated indirect funduscopy with scleral
depression and prophylactic treatment of any retinal lesion
predisposing for the development of a retinal detachment
before LASIK surgery can be performed.
Again, Dr Ruiz-Moreno and associates are to be com-
mended for a very interesting paper and for providing
additional information regarding the incidence of retinal
detachment after refractive surgery for the correction of
myopia.
J. FERNANDO AREVALO, MD
OLY AZAR-AREVALO, MD
Caracas, Venezuela
REFERENCES
1. Rodriguez A, Camacho H. Retinal detachment after refractive
surgery for myopia. Retina 1992;12(suppl):S46 –S50.
2. Arevalo JF, Ramirez E, Suerez E, et al. Incidence of vitreo-
retinal pathology within 24 months post laser-assisted in situ
keratomileusis (LASIK). Ophthalmology. Forthcoming.
3. Schepens CL. Retinal detachment and allied diseases. Phila-
delphia: WB Saunders, 1983:47.
AUTHOR REPLY
WE AGREE WITH DR AREVALO AND DR AZAR-AREVALO THAT
the treatment of a retinal detachment by scleral buckling
leads to a refractive problem in a patient with severe myopia
who had undergone surgery to correct his myopia. Scleral
buckling induced a myopic shift in our patients (mean
spherical equivalent after retinal detachment surgery Ϫ2.8 Ϯ
1.1 diopters; range, Ϫ1.00 to Ϫ4.50, vs mean spherical
equivalent previous retinal detachment surgery Ϫ1.1 Ϯ 0.7
diopters; range, 0.00 to Ϫ2.50). Retinal detachment can be
also treated by intravitreal injection of gas as internal tam-
ponade or by vitrectomy. The use of pneumatic retinopexy as
a suitable choice for retinal detachment has the advantages of
less cost, no refractive changes, and fewer complications;
however, in the presence of a phakic anterior chamber lens,
the possible flattening of the anterior chamber and the poor
visualization of the peripheral retina, along with the possibil-
ity of new breaks, whose incidence varies between 10.9% to
22.0%
1,2
after pneumatic retinopexy, in our opinion elimi-
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