This large, retrospective, register-based study found that phacoemulsification resulted in a four-fold increased risk of retinal detachment compared to unoperated fellow eyes and that the risk of detachment in fellow unoperated eyes was higher in young males.
No one will (or even should) stop performing phacoemsulsification based on this study. However, this article highlights the importance of true informed consent with confirmation of patient understanding of the risks of intraocular surgery. This is especially true in younger males, high myopes and those undergoing refractive lens exchange.
The authors reviewed the charts of 202,226 patients identified via the National Patient Registry in Denmark who went uncomplicated first-eye phacoemulsification cataract surgery from 2000 through 2010. The fellow nonoperated eye was used as a reference.
They identified 110 retinal detachments in fellow nonoperated eyes. In these eyes, male sex and younger age were associated significantly with greater risk of retinal detachment.
They identified 465 pseudophakic retinal detachments among the cataract-operated eyes. The risk of post-cataract surgery retinal detachment was 4.23 times greater among these eyes than among the nonoperated fellow eyes. This risk was not significantly modified by sex and age, although it was somewhat higher in men compared with women and in the age group of 40-year-olds compared with the other age groups.
The overall risk of retinal detachment increased significantly during the first six postoperative months and then leveled off but remained significantly elevated for up to 10 years after cataract surgery.
The authors write that this study provides some indication of the pathophysiologic factors leading to pseudophakic retinal detachment. These include: (1) the surgical manipulation of the operated eye, (2) changes in the vitreous humor that lead to posterior vitreous detachment and subsequent proliferative RD, or (3) a combination these factors.