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I would like to share the following thoughts. Recently, I attended a workshop wherein there was a discussion about the strategy to be followed for after cataract in patients with previous high myopia (Prior to cataract surgery) and it was debated whether to do Yag laser or polishing of posterior capsule. Probably no consensus was reached.
I strongly feel that yag laser can be done in these patients after carefully screening the retinal periphery and treating preexisting retinal tear or lattice degeneration if any and if possible by laser treatment. If not possible, one should look at retina post laser periodically and treat if need be. I feel the results of retinal detachment surgery are quite predictable and successful in majority of patients if treated in time and treated well. The key is picking them up and fixing them at the earliest. The incidence of retinal detachment is not markedly more after yag laser. The demerit of polishing is that it requires repeated treatment and may be difficult to perform and is an intraocular surgery with all its risks.
I would like to share 2 patients of acute retinal detachment following yag capsulotomy who have been successfully buckled and vision has been restored (treated in last 4 months).
Case 1: He has multifocal IOL and developed retinal detachment post yag. He underwent scleral buckling and has improved to 6/12, N6 vision post op with attached retina.
Case 2: He had 6/9, N6 vision, he is one eyed and developed detachment (post yag laser) temporally as seen on fundus photo and he underwent scleral buckling with core vitrectomy and has maintained 6/6, N6 vision with attached retina. I have enclosed both pre and post op fundus photo montage
These patients are operated recently in last 4 months or so.
I analyzed my results of scleral buckling patients last year and this year and found out interesting observations as follows.
Year 2009:
54 % (20/37) patients had 6/18 or better vision; & 33% (12/37) had 6/9,6/6 vision post scleral buckling operation.
Year 2008
57% (12/21) patients had 6/18 or better vision; and 33% (7/21) had 6/9,6/6 vision post scleral buckling operation.
These figures are small but they do point that result of early surgery in retinal detachment yield better results.
I believe if patient can follow up properly for screening, yag laser does not create that big problem and if patient develops detachement and is treated in time results are very satisfying. The caution is it may not be overdone.
