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Long-term complications of refractive lens exchange

Higher rate of PCO after RLE than after cataract surgery, due to the younger age of patients

Leigh Spielberg

Posted: Wednesday, February 15, 2017

Oliver Findl MD

Oliver Findl MD

What happens to our patients’ eyes after refractive lens exchange (RLE)? This was the question addressed by Oliver Findl MD, Vienna, Austria, during the session on ‘Long-Term Complications of Refractive Surgery’ at the 21st ESCRS Winter Meeting in Maastricht, The Netherlands.

“The three primary problems we have to worry about are cystoid macular edema, posterior capsular opacity (PCO) and retinal detachment (RD),” said Dr Findl.  Of these, retinal detachment is the most important, as the others are usually either self-limiting or easily treatable.

“We see a higher rate of PCO after RLE than after cataract surgery, due to the younger age of patients,” said Dr Findl. This is important because YAG capsulotomy, particularly in the young, myopic patient population that often undergoes RLE, significantly increases the risk of retinal detachment.

Each millimeter of axial length may increase RD risk after capsulotomy by a factor of 1.5

“In fact, each millimeter of axial length may increase RD risk after capsulotomy by a factor of 1.5,” warned Dr Findl. Other risk factors include male gender and age less than 60 years, and most detachments occur within the first five years after surgery.

This might be related to the postoperative occurrence of a posterior vitreous detachment (PVD), which vastly increases the risk of RD in eyes that had not yet undergone prior to surgery.

The ESCRS is currently investigating the problem with the MyopReD study. This international, multicentre study will determine the precise influence of PVD on RD rates after lens surgery in over 600 myopic eyes with an axial length of 25.00mm or more.