These Factors Up Retina Detachment Risk by 16x in Marfan

TOPLINE:

In children with Marfan syndrome who undergo lens removal, the risk for retinal detachment increases 16-fold when capsular residue is present and by 30% with increase in axial length.

METHODOLOGY:

Researchers assessed the risk factors for retinal detachment in 85 children (158 eyes; mean age at surgery, 5.3 years; 58% boys) with Marfan syndrome who had surgery to remove a lens between January 2010 and January 2020.All patients underwent a comprehensive ophthalmologic examination before surgery and at each follow-up which included best-corrected visual acuity, evaluation of anterior and posterior segments, and intraocular pressure. Axial length and corneal curvature also were evaluated before surgery.The researchers collected data on capsular residue after surgery, implantation of intraocular lenses, and number of surgeries performed.The main outcome was the occurrence of a retinal detachment during the follow-up period after surgery.

TAKEAWAY:

At a mean follow-up of 11.5 years, 24 patients (35 eyes) developed retinal detachment, with multiple tears observed in the majority (65%) of the eyes.Incomplete removal of the capsular bag increased the risk for retinal detachment nearly 17-fold (odds ratio, 16.8, P=.01).The increase in axial length raised the risk by 30% (P=.03).The cumulative risk for retinal detachment after lens removal increased from 8% at 5 years to 15% at 10 years.

IN PRACTICE:

“When lens subluxation is important, capsular should be thoroughly and completely removed. Follow-up should be started early and continued for an extended duration after surgery, and physicians should be particularly cautious in patients with increased axial length and with a history of retinal detachment,” the authors wrote.

SOURCE:

Youssef Abdelmassih, MD, from the Pediatric Ophthalmology Department at the Rothschild Foundation Hospital, in Paris, France, led the study, which was published online on May 29, 2024, in the American Journal of Ophthalmology.

LIMITATIONS:

The study was retrospective in design, with many children lost to follow-up. Multiple surgeons performed lens removal with different lens types and implantation techniques, which could have affected the development of retinal detachment. The study was performed at a tertiary referral facility with a pediatric vitreoretinal department, which may have led to an overestimation of the incidence of retinal detachment as many patients were referred for the management of retinal detachment.