Modern Lens Surgery And Retinal Risks: What We Know About Detachment Rates

Refractive Lens Exchange is increasingly recognized as a viable refractive option for patients who are not suitable candidates for corneal surgeries or phakic intraocular lenses. However, concerns persist regarding the potential risk of retinal detachment following this procedure.

Systematic review and meta-analysis. Study was supported by the SRA 2023 (Systematic Review Award) of the ESCRS.

A systematic review and meta-analysis were conducted using Medline and Scopus. No limitations were imposed on publication date, language, or status at this stage. Studies were eligible for inclusion in the meta-analysis if they examined patients who had undergone either cataract surgery or RLE and reported complications or adverse events during the follow-up period. The primary outcome was RD incidence stratified by follow-up duration (<12 months, 12–24 months, >24 months). Secondary outcomes included RD risk in myopic vs. hypermetropic patients and a sub-analysis by age, comparing younger vs. older cohorts based on the median age.

Out of 2,415 full-text articles screened, 40 studies met the inclusion criteria, covering a total of 8,592,380 eyes. This included 20,264 eyes that underwent RLE and 8,572,116 eyes that underwent cataract surgery. In the RLE subgroup, the incidence of RD was 0.00016% [0.00000%; 0.00034%] for follow-up < 12 months, 0.0000% [0.0000%; 0.03102%] for 12–24 months, and 0.02312% [0.00984%; 0.03640%] for follow-up > 24 months (p < 0.01). In the cataract surgery subgroup, RD incidence for follow-up beyond 24 months was 0.01244% [0.00655%; 0.01832%], while for studies with missing follow-up data, it was 0.00429% [0.00221%; 0.00637%].

This meta-analysis indicates that the incidence of RD following RLE is approximately twice as high as that observed after cataract surgery, based on a follow-up period of at least 24 months (median 4 years). As a result, RD can be classified as a rare complication after cataract surgery (1 in 1,000 cases) and an uncommon complication following RLE (1 in 500 cases). Notably, heterogeneity within the RLE subgroup was minimal. However, some study limitations, including the lack of extended follow-up in certain cases and incomplete data on factors such as axial length or posterior vitreous detachment (PVD) status, may slightly impact result interpretation. While these findings offer significant insights, further research is needed.