Retinal Detachment After Cataract Surgery - Population Based Study Of 58624 Eyes From Swedish National Cataract Register

To analyze the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery, and to identify possible risk factors.

The rate of cataract surgery has increased over recent decades and concern has been expressed that the post-surgical incidence of rhegmatogenous retinal detachment (RRD) is also increasing, possibly due to the demographics of the patients undergoing surgery. There is a tendency towards operating younger patients who may have a greater risk of RRD as they have a longer life expectancy, and have often not developed posterior vitreous detachment.

Observational cohort study of patients undergoing cataract surgery in Region Skåne, southern Sweden, during 2015-2017 were retrieved from the Swedish National Cataract Register. These were then cross-referenced with cases of retinal detachment surgery performed at the Skåne University Hospital in Lund from 2015 to 2020. 

Among the 58 624 cases of cataract surgery, a total of 298 RRDs (0.51%) were identified up to the end of 2020. The mean time from cataract surgery to RRD was 667 days. A strong correlation was found between RDD and age: <60 years, incidence = 0.50%; 60-75 years, incidence = 0.14%, and >75 years, incidence = 0.04%. The correlation with axial length was also very strong: mean value 23.73 mm in those without RRD, and 25.13 mm in those with RRD (p<0.001). Sex was also strongly correlated to RDD; 68.8% of cases of RRD being men.  Among men younger than 60 years of age, with an axial length >25 mm, 9.46% exhibited RRD.In this group 30% had a vision of 0.7 or better and in the other eye the majority had a vision of 0.8 or better.

The three main risk factors for RRD following cataract surgery were found to be sex, age and axial length. The highest incidence of RRD (9.46%) were identified among men younger than 60 years of age and an axial length >25 mm. This risk has to be balanced by the benefit of 30% seeing 0.7 or better. Their is a need for an individual risk assessment.