Phacoemulsification Complications Declining

Jim Kling

July 16, 2012

July 16, 2012 — After adoption of phacoemulsification as the procedure of choice to repair cataracts, the risk for retinal detachment (RD) dropped significantly between 1989 and 2001, according to a study published in the July issue of the Archives of Ophthalmology. The study further evaluated additional risk factors for RD post–cataract surgery using phacoemulsification.

RD is the most common sight-threatening complication after cataract surgery, affecting 1% of people undergoing the procedure. Previous studies have suggested that risk for RD may remain heightened up to 10 years after phacoemulsification, but few studies followed-up patients for longer than 5 years.

To examine the long-term incidence and risk factors for RD after phacoemulsification, Antony Clark, MBBS, from the Eye and Vision Epidemiology Research Group and the Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia, conducted a retrospective analysis of 65,055 patients who underwent the procedure in Western Australia between January 1989 and December 2001. They used the Western Australian Data Linkage System to identify cases, focusing on those who required admission for RD surgery after phacoemulsification. They also limited the cases to those that were validated by medical record review.

Over the course of 10 years, the researchers identified 237 RD cases, for a 10-year cumulative incidence of 0.68% (95% confidence interval [CI], 0.56% - 0.83%). The crude incidence of RD after phacoemulsification declined by a mean of 19% for each year after 1989 (incidence rate ratio, 0.81; 95% CI, 0.77 - 0.84).

Using Cox proportional hazards regression modeling, the researchers identified significant risk factors that included year of surgery (hazard ratio [HR], 0.43; 95% CI, 0.28 - 0.66 [1999 - 2001 compared with 1989 - 1993]), age younger than 60 years at time of phacoemulsification (HR, 3.76; 95% CI, 2.83 - 5.00), male sex (HR, 1.91; 95% CI, 1.45 - 2.51), and anterior vitrectomy (HR, 27.60; 95% CI, 19.27 - 39.52).

The researchers found no associations between RD risk and hospital location, patient rural or remote locality, hospital cataract surgery volume, failed intraocular lens insertion, length of stay, or patient insurance status.

Much Lower Complication Rates With Current Techniques

"It's another indicator of how much better the current surgery is than the surgery we were doing 20 years ago. With either procedure, vision was 20/20 6 weeks out, but the complication rates are much lower now," Robert Feldman, MD, professor of ophthalmology and visual science at the University of Texas Health Science Center and president of the Robert Cizik Eye Clinic in Houston, told Medscape Medical News.

Still, RD is a complication that should be noted. "It is a risk that is present even decades after surgery, even though it is a relatively low risk, and it actually increases over time. Patients and clinicians need to discuss these risks so that they're aware of the symptoms," Abdhish R. Bhavsar, MD, director of research at the Retina Center of Minnesota in Minneapolis and clinical correspondent at the American Academy of Ophthalmology, told Medscape Medical News.

Dr. Bhavsar pointed to the higher risk for patients who were younger than 60 years at the time of surgery. "I think that's of critical importance," he stated.

Neither Dr. Feldman nor Dr. Bhavsar was involved in the research.

The study had some limitations. First, the authors were unable to ascertain and control for certain important risk factors, including axial length and Nd:YAG laser capsulotomy, because these were not recorded in the database. In addition, the researchers relied on readmission to the hospital for surgery, which may have underestimated the incidence of RD because the procedure can be performed in an outpatient setting.

Nonetheless, "[r]isk for RD after phacoemulsification has almost halved for each 5-year period since its adoption in the mid 1980s," the authors conclude, adding that "[y]ounger patient age and male sex at surgery significantly increased risk for RD. Phacoemulsification requiring anterior vitrectomy vastly increased risk for RD."

This study was supported by the Australian National Health and Medical Research Council Project. The authors and Dr. Feldman and Dr. Bhavsar have disclosed no relevant financial relationships.

Arch Ophthalmol. 2012;130:882-888. Full text