The risk for retinal detachment (RD) is 4-fold greater after pseudophakic cataract surgery than in untreated eyes, according to a large, population-based study published online September 7 in Ophthalmology.
RD is a known complication of phacoemulsification cataract surgery, but the magnitude and duration of the risk has been hard to measure. Soren S. Bjerrum, MD, from the Department of Ophthalmology at Glostrup Hospital in Copenhagen, Denmark, and colleagues analyzed data from a national registry that included 202,226 patients who had undergone phacoemulsification cataract surgery in 1 eye. The investigators used data on the patients' untreated eyes as a reference group to establish background risk.
"By using the fellow eye as control in each patient, we have been able to study the isolated effect of the cataract operation on the risk of pseudophakic [RD]," Dr. Bjerrum told Medscape Medical News. "These results are clinically relevant to the cataract surgeon and to ophthalmologists in general. The surgical procedure will, in broad terms, increase the risk of RD by a factor [of] 4, no matter the sex and age."
Ruling out other risk factors is important, the researchers argue, to get a true idea of the incidence of RD solely associated with cataract surgery. For example, Dr. Bjerrum and associates demonstrated that younger age and male sex are significant, independent risk factors for RD. "[T]he absolute risk of pseudophakic [RD] is much higher for young men because their risk of RD is much higher before they undergo cataract surgery," the authors write.
The researchers identified 575 patients who developed RD among patients who had initial, unilateral cataract surgery between 2000 and 2010 and were included in the Denmark National Patient Registry. Of those, 465 RDs occurred in an operated eye and 110 in a nonoperated eye. The authors calculated a crude pseudophakic RD risk ratio of 4.23 (95% confidence interval, 3.4 - 5.3; P < .00005), relative to baseline RD risk.
"It's a very good study. It is something we always think about," Rishi Singh, MD, from the Department of Ophthalmology at the Cleveland Clinic in Ohio, told Medscape Medical New. "We do cataract surgery on patients, and we are always worried about the potential risk for [RD] following surgery."
Dr. Singh said the absolute number of RDs, 465 out of 202,226 cataract surgeries, is reassuring. "The study confirmed that the rate of [RD] is very, very low. People should be reassured this is not a significant risk."
The study confirms that some patients appear to be predisposed to RD, regardless of surgery, Dr. Singh noted. "Basically, they found if you had a detachment in 1 eye and you were younger, you were likely to have another detachment in the fellow eye that was not operated on."
The investigators found that the risk for RD was highest in the first 6 months after surgery but remained elevated at 10 years, with a hazard ratio of approximately 3.
Although statistically significant, Dr. Singh said the low absolute numbers decrease the clinical significance of the long-term risk, noting, "I don't make much of that 10-year risk elevation...because it's a very small percentage of the total population."
The study was supported by Fight for Sight Denmark, the Svend Hansen Foundation, and the Synoptik Foundation. Dr. Bjerrum has disclosed that he is a lecturer for Alcon, and a coauthor has disclosed receiving financial support from Novartis and acting as a lecturer for Novartis and Alcon. The other authors and Dr. Singh have disclosed no relevant financial relationships.
Ophthalmol. Published online September 7, 2013. Abstract
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Cite this: Cataract Surgery May Up Retinal Detachment Risk 4-Fold - Medscape - Sep 13, 2013.