How does cataract surgery lead to a retinal detachment?

Cataract surgery, especially if the operation has complications, increases the risk of a retinal detachment. Cataracts are areas of cloudiness (opacities) that form in the lens. Following the introduction of extracapsular surgery, a modern method used almost exclusively today for the removal of cataracts, the risk of retinal detachment became far less. In extracapsular cataract surgery, part of the capsule of the lens is left in place so that the vitreous gel is undisturbed. Phacoemulsification is a type of extracapsular cataract surgery that utilizes a very high speed ultrasonic instrument to break up and suck out the clouded lens of the eye. The capsule that is left in the eye may at a later time become cloudy, necessitating opening the capsule by using a laser. Opening the capsule increases the risk of retinal detachment.

In intracapsular cataract surgery, the predominant surgical method used from 1965 to 1990, the entire lens was removed. The capsule at the back of the lens, therefore, was no longer present to hold the vitreous gel in place. Consequently, the vitreous gel moved forward, and the retina was subjected to increased pulling or traction on the retina from the vitreous, which led to tears of the retina. Today, if the capsule is broken, which can be a complication during extracapsular cataract surgery, the vitreous gel similarly can move forward and pull on the retina. This sequence can lead to a retinal tear and a detachment, especially during the first year after surgery.

What other factors are associated with a retinal detachment?

* Blunt trauma, as from a tennis ball or fist, or a penetrating injury by a sharp object to the eye can lead to a retinal detachment.

* A family history of a detached retina that is non-traumatic in nature seems to indicate a genetic (inherited) tendency for developing retinal detachments.

* In as many as 5% of patients with a non-traumatic retinal detachment of one eye, a detachment subsequently occurs in the other eye. Accordingly, the second eye of a patient with a retinal detachment must be examined thoroughly and followed closely, both by the patient and the ophthalmologist.

* Diabetes can lead to a type of retinal detachment that is caused by pulling on the retina (traction) alone, without a tear. Because of abnormal blood vessels and scar tissue on the retinal surface in some patients with diabetes, the retina can be lifted off (detached) from the back of the eye. In addition, the blood vessels may bleed into the vitreous gel. This detachment may involve either the periphery or central area of the retina.

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