Cataract surgery is one of the most common and successful procedures performed in the world, but it’s not without complications. Experts say pseudophakic retinal detachment (PRD) has received more attention lately because of its potential to “significantly antagonize the positive effects achieved by cataract surgery.”

An investigation published last week in Acta Ophthalmologica aims to provide a detailed analysis PRD and pseudophakic retinal break (PRB) risk factors.1 “Different groups have previously investigated the incidence of PRD with results that weren’t identical, but revealed an association between cataract surgery and PRD,” the researchers explained in their paper. “Considering the great number of cataract cases, these differences become relevant in absolute numbers and may be caused by multiple factors including differences in sample size, study design (national population studies vs. single-center studies), adjustment for retinal detachment in the general population, follow-up and inclusion criteria.”

The study authors reviewed the medical records of cataract surgeries performed between 1996 and 2017 at a tertiary center in Austria. This included 65,662 eyes who underwent phacoemulsification. Of those eyes, 393 were diagnosed with PRD (327 eyes) or PRB (66 eyes), with a cumulative incidence of 0.6%, during the follow-up period (median 7.1 years).

The researchers found a “hierarchy of risk factors” from adjusted hazard ratios that included the following, from highest to lowest risk:

  • Posterior capsular rupture (PCR)
  • Patient age <65 years (compared with those 75+)
  • Male sex
  • High myopia

In the current study, 1,267 eyes had PCR, but only 632 of those eyes (49.9%) had vitreous loss requiring anterior vitrectomy. The other 635 were managed without vitrectomy. “Analyzed separately, PCR with vitreous loss was more likely to result in PRD in our study, but PCT without vitreous loss was associated with PRD nevertheless,” the researchers noted. “Compared with uneventful surgery, time to PRD was significantly reduced following PCR and anterior vitrectomy, but time to PRD following PCR without the need for anterior vitrectomy was not.” They added that “PCR without anterior vitrectomy was, therefore, associated with an increased risk for, but not with a reduced time to, PRD.”

Interestingly, diabetes was associated with a lower risk of PRD or PRB. “Diabetes mellitus without traction was associated with a lower risk for PRD in our study and in a 2019 investigation but associated with an increased risk for PRD in a 2015 paper,2,3” the researchers wrote. “We can only speculate about the reasons for these inconsistent results and further investigations are needed to assess diabetes mellitus as a risk factor for PRD and PRB.”

They concluded that PCR was the risk factor most strongly associated with PRD. “We suggest careful patient information and postoperative follow-up in these patients,” the researchers wrote.

1. Gabriel M, Großpötzl M, Wallisch F, et al. In-depth analysis of risk factors for pseudophakic retinal detachments and retinal breaks. Acta Ophthalmologica. July 13, 2021. [Epub ahead of print].

2. Kim J, Ryu S, Hong J, et al. Incidence and risk factors for retinal detachment after cataract surgery in Korea: a nationwide population-based study from 2011 to 2015. Graefe's Arch Clin Exp Ophthalmol. 2019;257:2193-2202.

3. Daien V, Le Pape A, Heve D, et al. Incidence, risk factors, and impact of age on retinal detachment after cataract surgery in France: A national population study. Ophthalmology 2015;122:2179-85.