Risk factors defined for retinal detachment after cataract surgery

By Sarah Guy

Study results spanning 22 years show that the risk for retinal detachment (RD) after undergoing phacoemulsification for cataracts has fallen dramatically, but that younger, and male patients are more at risk for this adverse outcome than their older, female peers.

"Knowledge about the importance of such risk factors is important for physicians to guide preoperative counseling and postoperative review with patients," say Antony Clark (Curtin University, Perth, Western Australia) and co-researchers in the Archives of Ophthalmology.

The team also reports a cumulative increase in incidence of RD among phacoemulsification patients in whom an anterior vitrectomy was performed.

The study evaluated the long-term complications of phacoemulsification using data for 46,258 patients who underwent the procedure in Western Australia between 1989 and 2001.

A total of 237 (0.4%) of the cohort were re-admitted after a median 11 months for RD, with a cumulative RD incidence of 0.47% at 5 years after surgery and 0.68% by 10 years. The mean age of RD patients was 64.4 years, and the majority (62.4%) were men.

Clark and colleagues found that phacoemulsification patients under 60 years had a 3.76-fold increased risk for RD compared with their counterparts aged 60 years and older, and compared with women, men were 1.91 times more likely to have an RD, report the researchers.

In all, 643 patients had anterior vitrectomy performed at the time of their cataract surgery, and their 5-year cumulative incidence of RD rose from 8.3% to 15.0% during the study period. Regression analysis confirmed that anterior vitrectomy increased RD risk by a significant 29 times.

"These findings highlight the importance of close follow-up monitoring in patients whose cataract surgery has been complicated by posterior capsule rupture," writes the research team.

Overall, the cumulative incidence of RD declined significantly during the study period, even after adjustment for potentially confounding surgical, sociodemographic, and hospital factors, with 5-year incidence rates of 0.96% between 1989 and 1993, 0.43% between 1994 and 1998, and 0.25% between 1999 and 2001.

The fall "is likely due to surgeon learning curve, although other unmeasured factors, such as improvement in surgical technique and advances in equipment technology, may have contributed to this result," suggest Clark et al.

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