Original Paper •Travail original •Originalarbeit

Ophthalmologica 1993;206:76-82

Hidenobu Taniharaa Axial Length of Eyes with

Akira Negih
Shinichiro Kawanoc Rhegmatogenous
Hitoshi Ishigouokaa
Yoshiki Uedaa
Retinal Detachment
Satomi Yoshida-Suzukia
Hiwyuki Amanoa
Emiko SatoiY
Yoshihito Hondaa
a Department of Ophthalmology,
Faculty of Medicine,
Kyoto University;
b Section of Ophthalmology.
Tenri Hospital: Abstract
c Department of Ophthalmology,
We conducted a prospective study of 226 eyes with nontrau-
School of Medicine,
Teikyo University. Japan matic rhegmatogenous retinal detachment; we examined pa­
tient characteristics as well as changes in axial length and cor­
neal curvature induced by scleral buckling surgery. Eyes with a
round hole in lattice degeneration were characterized by axial
Key Words length that was longer than that of eyes with retinal tears with
Rhegmatogenous retinal and without lattice degeneration. Sex and age also correlated
detachment significantly with axial length. Surgically induced changes in
Axial length axial length depended upon the procedures performed, but
Corneal curvature the retinal detachment surgery primarily caused a change in
Buckling surgery the refractive status.

Introduction ment than are emmetropic or hyperopic eyes

Efforts are being made to determine risk
factors that are related to the development
of rhegmatogenous retinal detachment, al­
though the exact mechanisms that bring it
about remain unknown. Among the suspect­
ed risk factors, a number of authors seem to
agree on the influence of refractive error. For
example, myopic eyes arc at a greater risk of
developing rhegmatogenous retinal detach­
[1. 2], and the probability of retinal detach­
ment and of peripheral chorioretinal lesions is
thought to be greater with increasing degrees
of myopia [1, 3-7].
It has also been reported that scleral buck­
ling surgery for retinal detachment alters the
shape of the eyeball, changing both the axial
length of the eye and corneal curvature [8-12],
resulting in an alteration of the refractive sta­
tus [2,13,14]. Previous studies have revealed
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Received: Ilidenobu Tanihara. MD < 1993

August 28. 1992 Departm ent o f Ophthalmology S. Karger AG. Basel
Accepted: Faculty o f Medicine 0030-3755/93/
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September 4.1992 Kyoto University. 54 Shogoin kawahara-Cho 2062-0076 S2.75A)

Sakyo-ku. Kyoto 606 (Japan)
that, in most cases, encircling scleral buckles
induce myopia [2, 14], Astigmatism also may
be produced [13].
Unfortunately, most reports on the ocular
shape of eyes with retinal detachment have
consisted of a small number of cases or have
been retrospective studies. Herein, we de­
scribe a prospective study of 226 cases of non-
traumatic retinal detachment due to periph­
eral or equatorial retinal breaks in which we
examined the association between eye length
and age and sex of the patient, and analyzed
the occurrence and severity of changes in oc­
ular shape following the application of a scler­
al buckle.
Patients and Methods
To examine the characteristics of rhegmatogenous
retinal detachm ent. we included patients w ith thisdiag-
nosis who were referred to our facility from 1987
through 1989. We excluded patients who had either a
history of priorsurgery for retinal detachment. a severe
retinal disease, or any of the inflammatory ocular dis­
eases. In addition, all cases in which trauma could have
been implicated in the retinal detachment were exclud­
ed. Furthermore, patients with macular hole were ex­
cluded from this study because the correlation between
high myopia and macular hole has been well document­
ed. and because scleral buckling surgery is no longer
performed in most such cases. Between 1987 and 1989.
258 eyes were examined preoperatively and scleral
buckling surgery was performed. Follow ing a prospec­
tive accumulation of cases, patients with oral dialysis,
giant tears, retinal breaks in the posterior pole, and in
whom the retinal break could not be identified were
excluded from this study, because the numbers of con­
stituents of these specific typesof retinal break were too
small to ascertain, with any confidence, the predispos­
ing characteristics. A total of 226 eyes with retinal
breaks in the equatorial or peripheral region met these
criteria, and details about the types of retinal detach­
ments and breaks, age. sex. axial length and corneal
curvature of all patients were collected and analyzed.
The types of retinal break w'ere subdivided into four
groups: 75 eyes (33.2%) had a tractional tear (horse­
shoe tear and operculated hole) with or without retinal
hole (group T): 40 eyes (17.7%) had a round hole
Table 1. Preoperative characteristics
Inclusion criteria
(!) Eyes must have nontraumatic retinal detachment
with peripheral or equatorial retinal breaks.
(2) Eyes must not have a history of prior surgical treat­
ment for retinal detachment.
(3) Eyes must not have a history of severe retinal dis­
ease or inflammatory ocular disease.
(4) Cases with oral dialysis, giant tear, retinal breaks in
the posterior pole, macular hole and unfound reti­
nal break w'ere excluded.
Preoperative findings
Number of cases 226 eyes
Age. years 45.8118.2
Sex
men 149 eyes
women 77 eyes
Types of retinal breaks
tractional tear 75 eyes
round hole without tear 40 eyes
tractional tear associated with lattice 50 eyes
degeneration
round hole of lattice degeneration 61 eyes
(group H); 5()eyes (22.1%) had a tractional tear associ­
ated with lattice degeneration (group TL). and 61 eyes
(24.9%) had a round hole associated with lattice degen­
eration (group HL). There were 149 (65.9%) men and
77 (34.1%) women; the average age w'as 45.8 years.
Inclusion criteria and preoperative findings are sum­
marized in table 1.
Measurements of axial length and corneal curva­
ture were performed preoperatively. Postoperative
measurements were performed similarly at 2 weeks
and at 1 year after surgery. Corneal curvature was de­
termined as the average value of maximal and minimal
curvatures; the index of change was determined as the
postoperative value minus the preoperative value, di­
vided by the preoperative value, equals the value in
percentage.
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 Table 2. D istribution of age and sex am ong groups Table 3. Age and axial length“

Age, Group Axial length, S 50 years > 50 years Young/

years mm elderly
T H TL HL
ratio

^20 1 (1) 9 (23) 1 (2) 18 (30) s£23.0 5 (5) 26 (24) 0.19

21-30 4 (5) 7 (18) 2 (4) 15 (25) 23.1-24.0 12 (10) 33 (31) 0.36
3M 0 13 (17) 3 (8) 7 (14) 11 (18) 24.1-25.0 14 (12) 16 (15) 0.88
41-50 10 (13) 5 (13) 7 (14) 5 (8) 25.1-26.0 29 (25) 11 GO) 2.64
51-60 20 (27) 4 (10) 20 (40) 9 (15) 26.1-27.0 33 (28) 10 (9) 3.30
61-70 18 (24) 6 (15) 11 (22) 3 (5) 27.1-28.0 17 (14) 7 (6) 2.43
>71 9 (12) 6 (15) 2 (4) 0 (0) >28.1 8 (7) 5 (5) 1.60

Male/ 50/25 24/16 34/16 41/20 Total 118 (1(H)) 108 (100) 1.09
female, n
Ratio 2.00 1.50 2.13 2.05 Values in parentheses are percentages.
a Young patients had a significant preponderance of
Values in parentheses are percentages. eyes with longer axial length. p<0.01.

Results with or without lattice degeneration occur

Age and Sex o f Patients
Of the 75 patients in group T. 57 (76%) pa­
tients were >40 years old. while 21 (53%) of
the 40 patients in group H were >40 years
old. Thus in eyes without lattice degenera­
tion, a significantly greater number of elderly
patients had horseshoe tears than round holes
(X: test, p<0.05). As for cases or retinal
breaks associated with lattice degeneration.
40 (80%) of the 50 patients in group TL and 17
(28%) of the 61 patients in group HL were
>40 years of age, which is also statistically
significant (x2 test, p<0.01). In addition,
there is a significant correlation between
young age and the presence of lattice degener­
ation (x2test, p<0.05) (table 2).
The male/femalc ratio was >2.0 for pa­
tients with lattice degeneration (groups TL
and HL) and > 1.5 for patients without lattice
degeneration (groups T and H) (table 2).
Thus cases with round holes associated with
lattice degeneration occur predominantly in
young males, while cases of horseshoe tears
predominantly in the elderly.
Age and Axial Length
The average axial length of the 108 older
eyes was 24.3 mm. and that of the 118 younger
eyes was 25.8 mm. The distribution of axial
lengths reveals a significant preponderance of
eyes with longer axial length in the younger
group compared with the number in the elder­
ly group (Mann-Whitney test. p<0.01) (ta­
ble 3). The young/elderly ratios are 1.60-3.30
in cases with axial lengths >25.0 mm. while
those in cases with axial lengths < 25.0 mm are
0.19-0.88, indicating a significant correlation
between axial length and age (x2 test,
p<0.01). Axial lengths of between 23.1 and
24.0 mm were most common in the elderly
group, while lengths of between 26.1 and
27.0 mm were most common in the younger
group.
Sex and Axial Length
The average axial length in the 149 males
was 25.3 mm, and that in the 77 females was
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 Table 4. Sex and axial length“ Table 5. Type of retinal breaks and axial length '

Axial length, Male Female Male/ Axial Group

mm female length,
T H TL HL
ratio mm

<23.0 19(13) 12(16) 1.58 <23.0 9(12) 6(15) 14 (28) 2 (3 )

23.1-24.0 21 (14) 24 (31) 0.88 23.1-24.0 20 (27) 13 (33) 6(12) 6(10)
24.1-25.0 23 (15) 7(9) 3.29 24.1-25.0 12(16) 5(13) 4 (8 ) 9(15)
25.1-26.0 25(17) 15 (19) 1.67 25.1-26.0 13(17) 3 (8 ) 9(18) 15 (25)
26.1-27.0 33 (22) 10(13) 3.30 26.1-27.0 11 (1-5) 3 (8 ) 9(18) 20 (33)
27.1-28.0 19(13) 5 (6) 3.80 27.1-28.0 5 (7 ) 7(18) 4 (8 ) 8(13)
>28.1 9 (6) 4 (5 ) 2.25 >28.1 5 (7 ) 3 (8 ) 4 (8 ) 1 (2)

Total 149 (100) 77 (100) 1.94 Total 75 (100) 40 (100) 50 (100) 61 (100)

Values in parentheses are percentages. Values ini parentheses are percentages.

“ Male patients had a significant preponderance of “ Significant difference in the distribution of TL vs.
eyes with longer axial length, p<().()l. HL (p<0.()5) and TL + H Lvs. T + H (p « ).< )5 ).

24.7 mm. The distribution of axial lengths
shows a significant preponderance of eyes
with a longer axial length to be in males com­
pared with those in females (Mann-Whitney
test, p <0.01) (table 4); the male/femalc ratio
is >2.25 in eyes with an axial length of
> 26.0 mm, while that of the total eases is 1.94.
Axial lengths >26.0 mm were found in 61
(41%) of the 149 eyes of the males and in 19
(24%) of the 77 females. There is thus a signif­
icant correlation between axial length and sex
(X2 test, p<0.05).
Type o f Retinal Breaks and Axial Length
Among the four groups based on types of
retinal breaks, the average axial length of eyes
in group HL was 25.7 mm, compared with
25.0. 24.9 and 24.9 mm for groups T, H
and TL, respectively. An axial length of
>26.0 mm was found in 29 (48%) of the 61
eyes in group HL but in only 29-34% of the
eyes with other types of retinal breaks
(groups T, H and TL). The greatest number
of eyes in group HL had an axial length of
H and TL, the lengths were <24.0 mm (ta­
ble 5). Eyes of groups HL and TL showed a
predominance of longer axial length com­
pared with those of groups H and T (Mann-
Whitney test, p < 0.05). Eyes in group TL also
showed a significant difference in the distribu­
tion of axial length when compared with
group HL (Mann-Whitney test, p<0.05),
while there was no significant difference be­
tween groups T and H.
Corneal Curvature
Preoperative measurement of the corneal
curvature was carried out in 197 eyes. The av­
erage corneal curvature of these eyes was
43.5 D. The average corneal curvature of eyes
in groupsT (63 eyes). H (37 eyes), TL (45
eyes) and HL (52 eyes) were 43.4. 43.9, 43.5
and 43.3 D. respectively.
Surgically Induced Change o f
Axial Length
In 161 eyes in which the axial length was
measured before surgery and at 2 weeks after
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between 26.1 and 27.0 mm, while, in groupsT, scleral buckling, both preoperative and post-
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 Table 6. Surgically induced change of axial length Table 7. Type of buckling and surgically induced
change of axial length “ 2 weeks after surgery

In d ex ,% 2 weeks 1 year Index, % Segmental Encircling

si-6.0 2 (1) 1 (3) s S -6 .0 1 (1) 1 (1)

-5.9 to -4.0 8 (5) 0 (0) -5.9 to -4.0 5 (5) 3 (4)
-3.9 t o -2.0 23 (14) 6 (15) -3.9 to -2.0 18 (19) 5 (7)
-1.9 to 0.0 61 (38) 8 (21) -1.9 to 0.0 42 (45) 19 (28)
0.1-2.0 33 (20) 12 (31) 0.1-2.0 18 (19) 15 (22)
2.1-4.0 16 (10) 8 (21) 2.1-4.0 6 (6) 10 (15)
4.1-6.0 8 (5) 1 (3) 4.1-6.0 1 (1) 7 (10)
>6.0 10 (6) 3 (8) >6.0 3 (3) 7 (9)

Total 161 (100) 39 (100) Total 94 (100) 67 (100)

Values in parentheses are percentages. Significant difference (p<0.0l).

operative axial length averages were 25.1 mm, Table 8. Type of buckling and surgically induced
showing no significant difference (tableó). change of corneal curvature
The change index was within ±2.0% in 94
In d ex .% Segmental Encircling
(58%) and > + 2.0% in 34 (21%) of the 161
eyes at 2 weeks after buckling surgery, and sï-6.0 0 (0) 1 (2)
was within ±2.0% in 20 (51%) and > + 2.0% -5.9 to -4.0 0 (0) 0 (0)
in 12 (31%) of 39 eyes that were remeasured 1 -3.9 to -2.0 2 (3) 1 (2)
year after buckling surgery. The change index -1.9 to 0.0 26 (33) 14 (23)
0.1-2.0 43 (54) 32 (51)
of axial length was within ± 2.0% in 60 (64%) 2.1-4.0 7 (9) 13 (21)
of 94 eyes after segmental buckling and in 34 4.1-6.0 2 (3) 2 (3)
(51%) of 67 eyes after an application of an >6.0 0 (0) 0 (0)
encircling buckle. The postoperative change
at 2 weeks after segmental buckling was a Total 80 (100) 63 (1(H))
shortening of the axial length (change index “ Values in parentheses are percentages.
<0%) in 66 (70%) of the 94 eyes, while this
change occurred in 28 (42%) of 67 eyes after
encircling buckling. This indicates that there
is a significant correlation between the surgi­ Surgically Induced Change o f
cal procedure and change in axial length (y: Corneal Curvature
test. p<0.01) (table 7). Thus an encircling Measurement of the corneal curvature was
buckle causes elongation of the eye in most carried out in 143 eyes at 2 weeks and in 30
cases, while segmental buckling may cause eyes at 1 year after surgery. Change indices
shortening. Segmental buckling caused an av­ were within ± 2.0% in 69 (86%) of the 80 eyes
erage decrease in axial length of 0.2 mm. and > + 2.0% in 9 of the 80 eyes at 2 weeks
while an encircling buckle increased axial after segmental buckling operations, and
length by an average of 0.3 mm. within ± 2.0% in 46 (73%) and > + 2.0% in 15
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(24%) of the 63 eyes after encircling buckling
operations (table 8). Postoperative change in­
dices at 1year are within ± 2.0% in 16 of the 17
eyes after segmental buckling operations, and
in 10 of the 13 eyes after encircling buckling
operations. The average change index of the
143 eyes at 2 weeks and that in the 30 eyes at 1
year are 0.67 and 0.31%, respectively. Both
segmental buckling and encircling buckling
caused an average increased corneal curva­
ture of 0.3 D.
Discussion
We have presented data regarding patient
characteristics and axial length of eyes with
nontraumatic rhegmatogenous retinal de­
tachment studied prospectively. It has been
reported that rhegmatogenous retinal detach­
ments occur most commonly in persons who
are between 40 and 70 years of age [15], and
that there is a significant correlation between
the type of retinal break and age [3,16,17], as
shown in our series. We also noted a predilec­
tion for retinal detachment with retinal
breaks, other than a macular hole, to occur in
men, as has been reported [15]; the male/
female ratio in our total scries was 1.94, and
each group (groups T, H , TL and HL) showed
a preponderance of males. These associations
between age, sex and type of retinal break arc
in agreement with previous reports, suggest­
ing that the patients in our series may share
common features with the patients reported in
previous studies.
The previously described preponderance
of round holes associated with lattice degener­
ation and the longer axial length in younger
patients was confirmed in our series [10, 17,
18]. Bycr [19], in studying the natural history
of asymptomatic retinal breaks, noted a sig­
nificant correlation between myopia and the
presence of retinal detachment; he noted also
a similar correlation in lattice degeneration
[ 20].
In our study, the average axial length of
eyes with tractional tears (groups T and TL)
was shorter than that of eyes with round
holes associated with lattice degeneration
(group HL), suggesting that the refractive er­
ror associated with retinal breaks may be
caused primarily by the shape of these eyes.
Surgical manipulation of the sclera fre­
quently creates changes in refractive error: a
scleral buckle may cause axial lengthening or
shortening, depending on the amount of in­
dentation. while scleral resection usually re­
sults in axial length shortening and a hyperop­
ic shift in refractive error [11]. Constriction by
an encircling buckle will cause a lengthening
of the eyeball and a myopic shift in refractive
error. The effect of a scleral buckle is an in­
dentation and a reduction in the radius of the
eyeball [12]; and high equatorial indentation
by buckles will produce a shortening of the
axial length and a hyperopic shift in refractive
error, while a low buckle may cause the in­
verse effect [14]. Our results show that the
average postoperative change of the axial
length was -0 .2 mm after segmental buckling
and 0.3 mm after the application of an encir­
cling buckle; this could induce a refractive
change of 0.5 D to hyperopia and 0.8 D to
myopia, since 1-mm increments of the axial
length are thought to induce a myopic shift of
2.6 D in phakic eyes [14], However, the post­
operative shift in refractive error may not only
be caused by a change in eye length, but also
by an alteration in corneal curvature [13, 21].
The average myopic change after either seg­
mental buckling or placement of an encircling
buckle was 0.3 D. This indicates that a myopic
change in refractive status after scleral buck­
ling is produced primarily by the change in eye
length, and that an encircling buckle causes a
myopic shift in refractive status due to chang­
es in both eye length and corneal curvature.
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while a myopic shift due to a change of corneal
curvature can be decreased or nullified by a
hyperopic shift due to shortening of the eye
length in segmental buckling.
In addition to changes in the ocular shape,
however, other components such as intraoc­
ular pressure and displacement of the lens,
lens thickness, impaired accomodation, and
shallowing of the anterior chamber may be
involved with refractive changes [8, 22], Al­
though the exact mechanisms by which retinal
detachment surgery alters refractive status re­
main unknown, our results indicate that axial
length and corneal curvature are contributing
factors. We found that refractive change after
buckling surgery may be caused primarily by
the change in axial length and depends on the
procedure performed. These data regarding
the ocular shape of eyes with retinal detach­
ment should be helpful in choosing the appro­
priate surgical treatment for retinal detach­
ment.

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