Retinal Detachment & Cataract Surgery

A 57-year-old woman presented with a referral for cataract surgery. Her best-corrected visual acuity (BCVA) was 20/60 in the right eye and 20/50 in the left eye. Bilateral cataracts were graded as 2–3+ nuclear sclerosis and 2+ nuclear cortical changes. Fundus examination and OCT evaluation of the macula were normal, and computerized topography revealed no abnormalities.

 

Trauma and Retinal Detachment
Approximately one month after her initial consultation and prior to cataract surgery, the patient sustained head trauma caused by a seagull striking her head while on a beach in Mexico. She reported significant impact and instability following the injury. Two days later, during her return flight to Canada, she experienced a curtain-like visual obstruction in her right eye. She sought emergency care, and a diagnosis of retinal detachment was made. The retina was successfully repositioned with an intravitreal gas injection.

Six months after the retinal detachment, the patient underwent cataract surgery with the implantation of an enhanced monofocal intraocular lens (IOL) in both eyes. The procedure was uneventful. One month postoperatively, her BCVA improved to 20/30 in the right eye and 20/20 in the left eye.

1. BLUNT OCULAR TRAUMA AND RETINAL DETACHMENT:

Blunt trauma can cause significant ocular injury, including:

In this case, the head trauma likely caused a vitreous detachment, leading to a retinal tear and subsequent retinal detachment. There were no clinical symptoms of a brain complication such as concussion, cranial nerve palsies, pupillary abnormalities, occipital lobe injury, esophoria, exophoria, or lack of normal physiological fusion.

 

2. IMPACT OF RETINAL DETACHMENT REPAIR ON IOL SELECTION:

The use of an intravitreal gas injection rather than scleral buckling minimized changes to the eye’s axial length, preserving accuracy in IOL power calculations that were obtained prior to the retinal detachment.

3. POST-RETINAL DETACHMENT VISUAL PROGNOSIS:

Patients with macula-involving retinal detachment often experience reduced BCVA despite successful repair. Preoperative OCT imaging prior to cataract surgery is essential for evaluating macular health (e.g., identifying epiretinal membranes or cystoid macular edema) and counseling patients on potential visual outcomes and IOL options.

4. RISK OF RETINAL DETACHMENT IN THE FELLOW EYE:

 

The risk of bilateral retinal detachment (RD) is significant, with the majority of second-eye detachments occurring within two years of the first. Patients should be aware of the increased risk of RD in the fellow eye.