Calculation of Intraocular in Cases Of Retinal Detachment

Background: Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that often requires pars plana vitrectomy (PPV). In phakic patients, combined phacoemulsification-vitrectomy (phacovitrectomy) is frequently performed to avoid subsequent cataract surgery. However, accurate intraocular lens (IOL) power calculation in eyes with RRD is challenging, as axial length (AL) measurements can be altered by retinal detachment, particularly when the macula is involved, potentially leading to refractive errors postoperatively. Aim of the study:: To evaluate changes in AL and IOL power in patients with macula-off RRD undergoing PPV ± phacoemulsification, and to assess their impact on refractive and visual outcomes, using IOL Master biometry. Methods:This prospective study included 60 eyes: 30 with macula-off RRD undergoing PPV ± phacoemulsification (Group 1) and 30 cataract patients undergoing phacoemulsification only (Group 2, control). Pre- and postoperative AL, IOL power, intraocular pressure (IOP), refraction, and best-corrected visual acuity (BCVA) were recorded. Patients were followed up at 1 week, 1 month, and 4 months postoperatively. Results: In Group 1, mean AL increased significantly from 21.9 ± 2.5 mm preoperatively to 25.0 ± 2.0 mm postoperatively (p = 0.001), whereas AL remained stable in controls. IOL power decreased markedly postoperatively in Group 1 (26.7 ± 7.9 D to 16.0 ± 4.6 D; p = 0.001) but showed no significant change in controls. Both groups demonstrated significant postoperative refractive improvement, with comparable final spherical equivalents at 4 months (p = 0.13). BCVA improved significantly in all cases, though final vision was better in the control group. Conclusions:RRD surgery, especially with macular involvement, causes significant biometric changes that can compromise refractive predictability in combined phacovitrectomy. Surgeons should account for potential AL measurement errors, consider fellow-eye data, and adjust IOL calculations accordingly to enhance postoperative visual and refractive outcomes.