Risk of Retinal Detachment after Cataract Extraction, 1980–2004: A Population-Based Study

doi:10.1016/j.ophtha.2006.05.054

Ophthalmology

Volume 113, Issue 11, November 2006, Pages 2026-2032

Presented in part at: American Ophthalmological Society Annual Meeting, May 24, 2006, Half Moon Bay, California.

https://doi.org/10.1016/j.ophtha.2006.05.054 Get rights and content

Purpose

To estimate the long-term cumulative risk of retinal detachment (RD) after cataract extraction (CE).

Design

Retrospective cohort study and nested case–control study.

Participants

All residents of Olmsted County, Minnesota who had CE from 1980 through 2004 (10 256 CEs in 7137 residents) and were diagnosed subsequently with RD in the same period. Two controls chosen from the primary cataract surgery cohort were matched to each RD case by age, gender, and duration of follow-up.

Methods

Cases were identified through the Rochester Epidemiology Project databases. Records were reviewed to confirm case status and ascertain risk factor information. The observed probability of RD after CE was estimated using the Kaplan–Meier method. A cumulative probability ratio of RD after CE was determined by comparing the observed probability of RD and the expected probability of RD in residents without CE. Logistic regression models assessed differences between cases and controls.

Main Outcome Measures

Probability of and risk factors associated with RD after CE.

Results

Eighty-two cases of RD were identified. The cumulative probability of RD increased in a nearly linear manner over the 25-year study period. At 1, 5, 10, 15, and 20 years after extracapsular CE (ECCE) and phacoemulsification, cumulative probabilities of RD were 0.27%, 0.71%, 1.23%, 1.58%, and 1.79%, respectively. There was no significant difference in the probability of RD after ECCE when compared with phacoemulsification (P = 0.13). The cumulative probability ratio of RD at 20 years after ECCE and phacoemulsification remained 4.0-fold (95% confidence interval, 2.6–5.4) higher than would be expected in a similar group of residents not undergoing CE (P<0.001). Male gender, younger age, myopia, increased axial length, and posterior capsular tear were associated significantly with RD (P<0.01).

Conclusions

The cumulative risk of RD after ECCE and phacoemulsification is increased for up to 20 years after surgery.

Section snippets

Materials and Methods

The institutional review board of Mayo Clinic College of Medicine approved the protocol for the study of this cohort.

Results

Medical record review identified 91 potential cases with a documented RD after CE. Exclusion of 9 nonresidents left 82 incident cases of pseudophakic RD in 79 residents. The mean age at RD diagnosis was 65±15 years (± standard deviation) (range, 11–93), with 40 of 82 cases (49%) in residents younger than 65. Among residents with a pseudophakic RD, the mean age at CE was 61±16, with 49 of 82 cases (60%) in residents younger than 65 at the time of cataract surgery. All residents were Caucasian.

Discussion

The findings of our population-based cohort study demonstrate that the risk of RD after ECCE and phacoemulsification increased in a nearly linear manner in the 25-year period 1980 through 2004. We report a cumulative probability of RD that increased from 0.27% at 1 year after CE to 1.79% at 20 years. At 20 years after ECCE and phacoemulsification, the risk of RD remained 4 times higher than would be expected in a comparable group of residents who did not have cataract surgery.

There is a lack of

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Cited by (74)

Risk Factors for Retinal Detachment Repair After Pediatric Cataract Surgery in the United States
2022, Ophthalmology Science
To determine the cumulative incidence of retinal detachment (RD) repair following pediatric cataract surgery and identify the associated risk factors.
US population-based insurance claims retrospective cohort study.
Patients ≤ 18 years old who underwent cataract surgery in 2 large databases: Optum Clinformatics (2003–2021) and IBM MarketScan (2007–2016).
Individuals with ≥ 6 months of prior enrollment were included, and those with a history of RD, RD repair, traumatic cataract, spherophakia, or ectopia lentis were excluded. The primary outcome was time between initial cataract surgery and RD repair. The risk factors investigated included age, sex, persistent fetal vasculature (PFV), prematurity, intraocular lens (IOL) placement, and pars plana lensectomy approach.
Kaplan–Meier estimated cumulative incidence of RD repair 5 years after cataract surgery and hazard ratios (HRs) with 95% confidence intervals (CIs) from multivariable Cox proportional hazards regression models.
Retinal detachment repair was performed on 47 of 3289 children included in this study. The cumulative incidence of RD repair within 5 years of cataract surgery was 2.0% (95% CI, 1.3%–2.6%). Children requiring RD repair were more likely to have a history of prematurity or PFV and less likely to have an IOL placed (all P < 0.001). Factors associated with RD repair in the multivariable analysis included a history of prematurity (HR, 6.89; 95% CI, 3.26–14.56; P < 0.001), PFV diagnosis (HR, 8.20; 95% CI, 4.11–16.37; P < 0.001), and IOL placement (HR, 0.44; 95% CI, 0.21–0.91; P = 0.03). Age at surgery, sex, and pars plana lensectomy approach were not significantly associated with RD repair after adjusting for all other covariates.
Approximately 2% of patients will undergo RD repair within 5 years of pediatric cataract surgery. Children with a history of PFV and prematurity undergoing cataract surgery without IOL placement are at the greatest risk.
Associated factors with pseudophakic retinal detachment: Long-term follow-up in a Colombian population
2022, Archivos de la Sociedad Espanola de Oftalmologia
Identificar factores asociados a la aparición de desprendimiento de retina pseudofáquico en pacientes con antecedente de cirugía de catarata.
Estudio retrospectivo de casos y controles de 802 ojos de 783 pacientes con antecedente de cirugía de catarata. Los casos fueron pacientes con desprendimiento de retina pseudofáquico (n = 258 ojos), mientras que los controles fueron pacientes con cirugía de cataratas que no desarrollaron desprendimiento de retina durante un período de seguimiento de 10 años (n = 544 ojos).
La edad de la cirugía de cataratas entre los casos fue menor que en el grupo control (57 ± 13 vs. 67 ± 14 años, respectivamente; p < 0,0001). La edad al desprendimiento de retina fue de 59 ± 13 años (rango 6-88) y el tiempo entre la cirugía de catarata y el desprendimiento de retina tuvo una mediana de 2 años (rango intercuartílico 1-4), con un rango de un mes a 14 años. Los factores asociados para el desprendimiento de retina pseudofáquico fueron la edad más joven (< 50 años: razón de probabilidad ajustada [ORa] = 18,03; intervalo de confianza del 95% [IC 95%] = 5,92-54,87; 50-59 años: ORa = 10,09, IC 95% = 3,37-30,23 y 60-69 años: ORa = 5,48, IC 95% = 1,88-15,93), sexo masculino (ORa = 3,71, IC 95% = 2,54-5,44), vitrectomía anterior (ORa = 3,26, IC 95% = 1,16-9,16), antecedentes de desprendimiento de retina en el ojo contralateral (ORa = 6,95, IC 95% = 3,15-15,31) y complicaciones intraoperatorias durante la extracción de cataratas (ORa = 7,45, IC 95% = 3,54-15,69).
Este es el primer artículo de factores asociados al desprendimiento de retina pseudofáquico en población colombiana. Se encontró que las complicaciones quirúrgicas, el sexo y la edad estaban asociados con el desprendimiento de retina. Los pacientes deben ser conscientes de estos riesgos potenciales para tomar decisiones informadas sobre su salud ocular.
To identify associated factors with the appearance of pseudophakic retinal detachment in patients with history of cataract surgery.
Retrospective case–control study of 802 eyes of 783 patients with history of cataract surgery. Cases were patients with pseudophakic retinal detachment (n = 258 eyes), while controls were patients with cataract surgery who did not developed retinal detachment during a 10-year follow-up period (n = 544 eyes).
Age at cataract surgery among cases was lower than in the control group (57 ± 13 vs. 67 ± 14 years old, respectively; P < .0001). Age at retinal detachment was 59 ± 13 years old (range 6–88) and the time between the cataract surgery and the retinal detachment had a median of 2 years (interquartile range 1–4) with a range of 1 month to 14 years. Associated factors for pseudophakic retinal detachment were younger age (< 50 years: adjusted odds ratio [aOR] = 18.03, 95% confidence interval [95% CI] = 5.92–54.87; 50–59 years: aOR = 10.09, 95% CI = 3.37–30.23; and 60–69 years: aOR = 5.48, 95% CI = 1.88–15.93), male sex (aOR = 3.71, 95% CI = 2.54–5.44), anterior vitrectomy (aOR = 3.26, 95% CI = 1.16–9.16), history of retinal detachment in the fellow eye (aOR = 6.95, 95% CI = 3.15–15.31), and intraoperative complications during cataract extraction (aOR = 7.45, 95% CI = 3.54–15.69).
This is the first report of associated factors with pseudophakic retinal detachment in a Colombian population. Surgical complications, sex, and age were found to be associated with retinal detachment. Patients should be aware of these potential risks to make informed decisions about their eye health.
Genome-wide association meta-analysis of 88,250 individuals highlights pleiotropic mechanisms of five ocular diseases in UK Biobank
2022, eBioMedicine
Citation Excerpt :
Close genetic relationship between AMD and DR is also reflected in their similar genetic correlations with several risk factors such as fat, insomnia, and lack of physical activity. The second group contained RD and myopia, with the highest genetic correlation estimate, have characterized by axial elongation.44,45 Overall, these results suggest significant pairwise genetic correlations among multiple ocular disorders and a higher level of genetic architecture that points to broader domains that underlie genetic risk for ocular pathology.
Ocular diseases may exhibit common clinical symptoms and epidemiological comorbidity. However, the extent of pleiotropic mechanisms across ocular diseases remains unclear. We aim to examine shared genetic etiology in age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, retinal detachment (RD), and myopia.
We analyzed genome-wide association analyses for the five ocular diseases in 43,877 cases and 44,373 controls of European ancestry from UK Biobank, estimated their genetic relationships (LDSC, GNOVA, and Genomic SEM), and identified pleiotropic loci (ASSET and METASOFT).
The genetic correlation of common SNPs revealed a meaningful genetic structure within these diseases, identifying genetic correlations between AMD, DR, and glaucoma. Cross-trait meta-analysis identified 23 pleiotropic loci associated with at least two ocular diseases and 14 loci unique to individual disorders (non-pleiotropic). We found that the genes associated with these shared genetic loci are involved in neuron differentiation (P = 8.80 × 10⁻⁶) and eye development systems (P = 3.86 × 10⁻⁵), and single cell RNA sequencing data reveals their heightened gene expression from multipotent progenitors to other differentiated retinal cells during retina developmental process.
These results highlighted the potential common genetic architectures among these ocular diseases and can deepen the understanding of the molecular mechanisms underlying the related diseases.
The National Natural Science Foundation of China (61871294), Zhejiang Provincial Natural Science Foundation of China (LR19C060001), and the Scientific Research Foundation for Talents of Wenzhou Medical University (QTJ18023).
Supercritical fluid technology for the development of innovative ophthalmic medical devices: Drug loaded intraocular lenses to mitigate posterior capsule opacification
2020, European Journal of Pharmaceutics and Biopharmaceutics
Supercritical impregnation technology was applied to load acrylic intraocular lenses (IOLs) with methotrexate to produce a sustained drug delivery device to mitigate posterior capsule opacification. Drug release kinetics were studied in vitro and used to determine the drug loading. Loaded IOLs and control IOLs treated under the same operating conditions, but without drug, were implanted ex vivo in human donor capsular bags. The typical cell growth was observed and immunofluorescence staining of three common fibrosis markers, fibronectin, F-actin and α-smooth muscle actin was carried out. Transparent IOLs presenting a sustained release of methotrexate for more than 80 days were produced. Drug loading varying between 0.43 and 0.75 ± 0.03 µg_drug·mg⁻¹_IOL were obtained when varying the supercritical impregnation pressure (8 and 25 MPa) and duration (30 and 240 min) at 308 K. The use of ethanol (5 mol%) as a co-solvent did not influence the impregnation efficiency and was even unfavorable at certain conditions. Even if the implantation of methotrexate loaded IOLs did not lead to a statistically significant variation in the duration required for a full cell coverage of the posterior capsule in the human capsular bag model, it was shown to reduce fibrosis by inhibiting epithelial-mesenchymal transformation. The innovative application presented has the potential to gain clinical relevance.
Frequency of Retinal Redetachment after Cataract Surgery in Eyes with Previous Scleral Buckling Surgery
2018, Ophthalmology Retina
To determine the cumulative risk and outcome of retinal redetachment after cataract surgery, in eyes with a history of retinal detachment repair by scleral buckling techniques.
Population-based, retrospective cohort study.
All phakic patients without previous ocular surgery or significant trauma who underwent scleral buckling surgery for rhegmatogenous retinal detachment between January 1, 2001, and December 31, 2010, at Norrlands University Hospital, Sweden (n = 537).
International Classification of Diseases 10 diagnosis codes corresponding to rhegmatogenous retinal detachment were used to identify all cases. Medical charts of all patients identified were reviewed to confirm the diagnosis. Any recurrence of retinal detachment and the visual outcome in these cases were examined. The frequency of redetachment and the time span from cataract surgery to redetachment surgery were analyzed.
Any redetachment surgery after cataract surgery, best-corrected visual acuity (BCVA).
Three hundred and one (56%) male and 236 (44%) female patients were identified. During the follow-up period, 145 of 537 patients (27%) had phacoemulsification surgery, with a median time span of 3.4 years after the retinal detachment repair. Male patients had cataract surgery significantly more often (31% vs. 22%; P = 0.036), and at an earlier age, than female patients (65.6 vs. 69.4 years; P = 0.013). Recurrence of retinal detachment occurred in 3 patients (3/145; 2.1%), at 2.4, 3.9, and 6.9 years after cataract extraction, and their final BCVA was 20/70, 20/25, and 20/30, respectively. The cumulative percentage of redetachment surgery after phacoemulsification was 1% up to 10 years after the scleral buckling surgery, as calculated by life table analyses. Ten years after cataract surgery, the cumulative percentage of redetachment surgery was 5% in eyes with previous scleral buckling surgery.
In patients with a history of previous scleral buckling surgery, the risk of redetachment after cataract surgery is low. In these patients, phacoemulsification can be performed safely and there is no need for extended postoperative attention. It is, however, important to inform all patients with previous retinal detachment surgery to seek prompt medical care if they experience symptoms of redetachment. This is important even several years after the cataract surgery was performed.
Incidence, Risk Factors, and Outcomes of Retinal Detachment after Pediatric Cataract Surgery
2018, Ophthalmology
To report the incidence of, and to estimate the long-term risk and predisposing factors and the surgical outcomes for, retinal detachment (RD) after pediatric cataract surgery.
Retrospective consecutive interventional case series.
During the study period 1996 to 2007 at a tertiary eye care institute, 481 eyes of 295 children aged below 16 years with no other ocular and systemic anomalies who underwent lensectomy, posterior capsulorrhexis, and anterior vitrectomy combined with primary intraocular lens implantation were included. The median follow-up was 66 months.
Kaplan–Meier estimates and Cox proportional hazard regression model were used for estimating cumulative risk and hazard ratio (HR), respectively. Difference between measured preoperative axial length and age-matched mean axial length (prior studies) was calculated, and was defined as age-adjusted axial length difference (ALD) (minus and plus denotes myopia and hypermetropia, respectively).
Cumulative risk and potential risk factors for RD.
Of the total, 12 eyes of 9 children developed RD after cataract surgery, with a median time of 70 months. The overall risk of RD was 5.5% at 10 years after cataract surgery. All 9 children were male. The multi-adjusted HR associated with increased risk of RD was 12.42 (95% confidence interval [CI], 2.91–53.01; P = 0.001) for eyes of children with intellectual disability and 21.93 (95% CI, 2.95–162.80; P = 0.003) for eyes of children with age-adjusted ALD < −1 mm (myopic). Retinal break associated with induction of posterior vitreous detachment was the most common (8 eyes) cause of RD. No surgical intervention was done in 2 eyes. Scleral buckle and vitrectomy combined with belt buckle were performed in 4 and 6 eyes, respectively. At final follow-up, 5 and 9 eyes had a visual acuity better than or equal to 6/18 and 6/60, respectively.
A 5.5% risk for RD is estimated for the first 10 years after cataract surgery in children with no known ocular and systemic anomalies. The risk significantly increases in a male, myopic, and intellectual disabled child. We emphasize the need for regular and long-term follow-up after pediatric cataract surgery.

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Manuscript no. 2006-406.

Supported in part by Research to Prevent Blindness, Inc., New York, New York, and the Mayo Foundation, Rochester, Minnesota.

No author has a financial or proprietary interest in any materials or methods mentioned.

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Original ArticleRisk of Retinal Detachment after Cataract Extraction, 1980–2004: A Population-Based Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

J Cataract Refract Surg

Ophthalmology

Mayo Clin Proc

J Cataract Refract Surg

Ophthalmology

Ophthalmology

J Cataract Refract Surg

Exp Eye Res

Ophthalmology

J Cataract Refract Surg

Original Article
Risk of Retinal Detachment after Cataract Extraction, 1980–2004: A Population-Based Study