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 Table of Contents    
Year : 2022  |  Volume : 15  |  Issue : 2  |  Page : 215-217  

Rhegmatogenous retinal detachment following femtosecond laser-assisted cataract surgery

1 Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, West Bengal, India
2 Department of Cataract and Refractive Surgery, Disha Eye Hospitals Pvt Ltd, Kolkata, West Bengal, India

Date of Submission23-Aug-2020
Date of Decision06-Apr-2022
Date of Acceptance30-Apr-2022
Date of Web Publication29-Jun-2022

Correspondence Address:
Dr. Subhendu Kumar Boral
Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, 88 (63A) Ghosh Para Road, Barrackpore, Kolkata - 700 120, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.ojo_308_2020

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Rhegmatogenous retinal detachment (RRD) following femtosecond laser-assisted cataract surgery (FLACS) has not been reported till date. We described the first case of RRD after FLACS. A 29-year-old male presented with complaints of sudden, painless dimness of vision in the left eye (LE) for the past 2 days. He was operated for refractive lens exchange in both eyes for high myopia using FLACS 3 months back. On examination, his LE vision was perception of light and accurate projection of rays with fundus showing bullous RRD. His right eye fundus was absolutely normal with 20/20 vision. A 25-gauge vitrectomy was performed in LE. The retina was settled with silicone oil (1300 centistokes) endotamponade. After 4 weeks, the patient gained 20/60 vision in LE with attached retina under silicone oil. RRD is a potential complication following FLACS and thus frequent follow-ups are required for high-risk patients after FLACS.

Keywords: Femtosecond laser, femtosecond laser-assisted cataract surgery, refractive lens exchange, retinal detachment

How to cite this article:
Boral SK, Agarwal D, Mohanta A. Rhegmatogenous retinal detachment following femtosecond laser-assisted cataract surgery. Oman J Ophthalmol 2022;15:215-7

How to cite this URL:
Boral SK, Agarwal D, Mohanta A. Rhegmatogenous retinal detachment following femtosecond laser-assisted cataract surgery. Oman J Ophthalmol [serial online] 2022 [cited 2022 Nov 29];15:215-7. Available from: https://www.ojoonline.org/text.asp?2022/15/2/215/349007

   Introduction Top

There has been unprecedented development in the field of cataract surgery, especially over the past few years. The earliest known management of cataract was practiced by Indian physician Sushruta. The technique, known as couching, involved penetrating eye with a sharp instrument to push the cataractous lens into the vitreous cavity. This indigenous, though effective procedure was popular for few centuries. The major developments which can be regarded as game changer in cataract surgery were development of intraocular lenses (IOLs) by Sir Harold Ridley in 1949, invention of phacoemulsification handpiece by Dr. Charles Kelman in 1967, and introduction of ophthalmic viscosurgical devices in the early 1970s. As a result, modern-day treatment of choice for cataract is phacoemulsification. Cataract surgery took a major leap with the Food and Drug Administration (FDA) approval of femtosecond laser-assisted cataract surgery (FLACS) in 2010. With increasing popularity, FLACS has been compared with conventional phacoemulsification. No significant difference was found in posterior capsular rent between the two procedures, and vitreous loss has been reported to be significantly lesser in FLACS.[1] The incidence of rhegmatogenous retinal detachment (RRD) after phacoemulsification is 0.68% over 10 years.[2] Risk factors for RRD following cataract surgery are young age, high myopia, and male sex.[3]

To the best of our knowledge, retinal detachment has never been reported following FLACS. We report the first case of retinal detachment after FLACS in a young, myopic male patient.

   Case Report Top

A 29-year-old male presented with complaints of severe dimness of vision in the left eye (LE) for 2 days. He was operated for refractive lens exchange in both eyes (BE) for high myopia using FLACS 3 months back using the Catalys (Abbott/OptiMedica). Preoperative retinal examination had not revealed any peripheral treatable lesion in BE. Axial lengths were 26.99 mm in the right eye (RE) and 27.72 mm in LE. Femtosecond laser was used for capsulotomy, lens fragmentation, and corneal incision. Subsequent phacoemulsification was performed by CENTURION Vision System (Alcon Surgical) followed by implantation of Tecnis® 1 Aspheric Monofocal IOL.

On examination, the vision was 20/20 in RE and perception of light in LE. Intraocular pressure was 15 and 9 mmHg in RE and LE, respectively. Slit-lamp examination of BE revealed a well-centered posterior chamber IOL. Fundus examination of RE showed apparently healthy retina. LE showed a macula-off superior bullous RRD with posterior vitreous detachment (PVD) [Figure 1].
Figure 1: Preoperative status of the right eye with in-the-bag IOL (a) with attached retina without any peripheral treatable lesion, (b) and left eye with in-the-bag IOL, (c) with bullous retinal detachment, (d). OL: Intraocular lens

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A 25-gauge vitrectomy was performed in LE using Constellation Vitrectomy System (Alcon Surgical). Perfluorocarbon liquid was injected to stabilize the posterior pole. Two very small, horseshoe-shaped tears (HSTs) were noted at the extreme periphery at the inferotemporal and superonasal quadrants. Fluid-gas exchange and internal drainage of subretinal fluid were performed. Endolaser was applied surrounding both HSTs, as well as 360° periphery. Silicone oil was injected for tamponade. At the first follow-up, the retina was attached throughout with well-barraged breaks [Figure 2]. The patient gained 20/40 vision in LE at 4 weeks.
Figure 2: (a and b) Intraoperatively, two HSTs were identified (white arrows), (c and d) postoperative fundus status with attached retina all throughout and well-barraged breaks (white arrow). HSTs: Horseshoe-shaped tears

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   Discussion Top

PVD has been reported in 31% of eyes following phacoemulsification and in 16% of eyes after femtosecond-assisted laser in situ keratomileusis (LASIK).[4],[5] Hori et al. reported a case of RRD after femtosecond LASIK.[6] Retinal detachment following FLACS had not been reported previously. The possible mechanism of RRD in our case can be onset of PVD following FLACS, which induced retinal breaks near the vitreous base. Liquefied vitreous entered subretinal space through these breaks, leading to RRD.

The probable mechanisms of initiation of PVD are multifactorial. First, the docking and undocking procedure is the most crucial step in FLACS. A study showed that the vacuum generated by suction ring causes anteroposterior elongation of the eyeball which leads to anterior movement of the lens and anterior hyaloid.[5] Compression, followed by sudden decompression of the eyeball, after undocking can result in vitreous turbulence, resulting in PVD. Contractile force on lens is another pathomechanism. Manual opening of corneal incisions can result in a sudden collapse of anterior chamber, causing changes in vitreous dynamics and initiation of PVD. Another possible explanation is anterior movement of vitreous after the replacement of crystalline lens by IOL.

To conclude, RRD can be a potential complication following FLACS. Detail preoperative retina evaluation, prophylactic barrage laser for risky peripheral lesions, and frequent postoperative follow-ups are needed following FLACS, especially in high-risk cases like young myopes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Abell RG, Darian-Smith E, Kan JB, Allen PL, Ewe SY, Vote BJ. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: Outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg 2015;41:47-52.  Back to cited text no. 1
Clark A, Morlet N, Ng JQ, Preen DB, Semmens JB. Risk for retinal detachment after phacoemulsification: A whole-population study of cataract surgery outcomes. Arch Ophthalmol 2012;130:882-8.  Back to cited text no. 2
Haug SJ, Bhisitkul RB. Risk factors for retinal detachment following cataract surgery. Curr Opin Ophthalmol 2012;23:7-11.  Back to cited text no. 3
Mirshahi A, Höhn F, Lorenz K, Hattenbach LO. Incidence of posterior vitreous detachment after cataract surgery. J Cataract Refract Surg 2009;35:987-91.  Back to cited text no. 4
Gavrilov JC, Gaujoux T, Sellam M, Laroche L, Borderie V. Occurrence of posterior vitreous detachment after femtosecond laser in situ keratomileusis: Ultrasound evaluation. J Cataract Refract Surg 2011;37:1300-4.  Back to cited text no. 5
Hori S, Shimada H, Hattori T, Nakashizuka H, Mizutani Y, Yuzawa M. Early onset of rhegmatogenous retinal detachment after LASIK with femtosecond laser. Jpn J Ophthalmol 2009;53:75-6.  Back to cited text no. 6


  [Figure 1], [Figure 2]


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