Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis

Presented at the Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 2022, Denver, Colorado and the American Society of Retina Specialists (ASRS) Annual Meeting, July 2022, New York, New York. This manuscript was accepted for presentation at the American Academy of Ophthalmology (AAO) Annual Meeting, October 2022, Chicago, Illinois.
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Objective

To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

Design

Retrospective cohort study.

Participants

Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017.

Methods

Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery.

Main Outcome Measures

Incidence and risk factors for RRD or RT within 1 year of cataract surgery.

Results

Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99–3.32; P < 0.001 and 1.79; 95% CI, 1.70–1.89; P < 0.001), and younger ages compared with patients aged > 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74–9.58; P < 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52–2.98; P < 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82–11.28; P < 0.001), hypermature cataract (1.61; 95% CI, 1.06–2.45; P = 0.03), complex cataract surgery (1.52; 95% CI, 1.4–1.66; P < 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15–1.34; P < 0.001), and high myopia (1.2; 95% CI, 1.14–1.27; P < 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39–46.49; P < 0.001).

Conclusion

In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged > 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Keywords

Cataract surgery
High myopia
Lattice degeneration
Rhegmatogenous retinal detachment
Retinal tear

Abbreviations and Acronyms

CI
confidence interval
CPT
Current Procedural Terminology
ICD
International Classification of Diseases
IR
incidence rate
IRIS
Intelligent Research in Sight
LD
lattice degeneraton
OR
odds ratio
RRD
rhegmatogenous retinal detachment
RT
retinal tear
PVD
posterior vitreous detachment
PCR
posterior capsular rupture

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Supplemental material available at www.ophthalmologyscience.org.

Disclosures:

All authors have completed and submitted the ICMJE disclosures form.

The authors made the following disclosures: D.M.W.: Volunteer – Wills Eye Alumni Society.

J.A.H.: Leadership – AAO Foundation Board.

L.H.: Consultant – TRUST (Treatment of Central Vein Occlusion using Stem Cell Study), Spectacle Prescribing in Early Childhood (SPEC), Village-Integrated Eye Worker Trial II (VIEW II), Azithromycin Reduction to Reach Elimination of Trachoma (ARRET), Kebele Elimination of Trachoma for Ocular Health (KETFO) Study, Sanitation, Water, And Instruction in Face-Washing for Trachoma (SWIFT II); Leadership – AUPO- Research Director Council, ARVO- Women’s Leadership Development Program.

M.A.K.: Grant – Regeneron; Consultant – Genentech, Apellis.

A.C.H.: Consultant – Alcon. The other authors have no proprietary or commercial interest in any materials discussed in this article.

HUMAN SUBJECTS: Human subjects were included in this study. This study adhered to the tenets of the declaration of Helsinki. Given the use of deidentified patient data from an established database, the study was exempt from Wills Eye Hospital Institutional Review Board (IRB) review.

No animal subjects were used in this study.

Author Contributions:

Conception and design: Morano, Khan, Zhang, Halfpenny, Wisner, Sharpe, Li, Tomaiuolo, Haller, Hyman, Ho.

Data collection: Morano.

Analysis and interpretation: Morano, Khan, Zhang, Halfpenny, Wisner, Sharpe, Li, Tomaiuolo, Haller, Hyman, Ho.

Obtained funding: N/A

Overall responsibility: Morano, Halfpenny, Hyman, Ho.

© 2023 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology.