The incidence of pseudophakic rhegmatogenous retinal detachment (RRD) has been reported as 0.2%–3.6%, depending on follow-up time and patient demographics. RRD occurs most frequently within 1 year of cataract surgery or 6 months after posterior capsulotomy. During the first postoperative year after phacoemulsification, the incidence of RRD ranges from 0.6% to 1.7%. The incidence of RRD is lower with small-incision phacoemulsification surgery than with large-incision ECCE and ICCE.
For all age groups and both sexes, eyes that have undergone cataract surgery have an approximately fourfold-higher risk of RRD than fellow phakic eyes. Uncomplicated cataract surgery and laser posterior capsulotomy are risk factors for RRD in part because they are risk factors for early onset of PVD. Myopic eyes have a much higher risk of RRD whether pseudophakic or phakic, and this risk rises with each additional millimeter of axial length. Whether phakic or pseudophakic, additional risk factors for RRD include axial myopia (6- to 10-times-greater risk with axial length >25 mm), younger age (4-times-greater risk with age <60 years), male sex, lattice degeneration of the retina, a previous retinal tear or detachment in the surgical eye, a history of retinal detachment in the fellow eye, and a family history of retinal detachment.
After cataract surgery complicated by posterior capsule rupture, the risk of postoperative RRD is increased at least tenfold compared with pseudophakic eyes with an intact capsule. Some studies have reported that Nd:YAG laser posterior capsulotomy increases the risk for RRD, whereas other studies found no evidence of increased risk with capsulotomy. Neither the size of the capsulotomy nor the total energy delivered is thought to increase risk.
Pars plana vitrectomy with or without a scleral buckle is most commonly used to repair RRD; the success rate is approximately 85% with 1 operation and ultimately 98% with multiple procedures. (See also BCSC Section 12, Retina and Vitreous.)
Bjerrum SS, Mikkelsen KL, La Cour M. Risk of pseudophakic retinal detachment in 202,226 patients using the fellow nonoperated eye as reference. Ophthalmology. 2013;120(12): 2573–2579.
Clark A, Morlet N, Ng JQ, Preen DB, Semmens JB. Risk for retinal detachment after phacoemulsification: a whole-population study of cataract surgery outcomes. Arch Ophthalmol. 2012;130(7):882–888.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.