A US-based multivariate analysis of IRIS Registry data reveals that lattice degeneration significantly increases the risk of developing retinal detachment or retinal tear after cataract surgery, with younger age and male sex among other identified risk factors.
Study design
This retrospective analysis used data from the AAO IRIS Registry to assess the incidence of rhegmatogenous retinal detachment (RRD) or retinal tear (RT) within 1 year following cataract surgery in the United States. Current procedural terminology (CPT) codes were used to identify eyes that underwent cataract surgery and subsequently developed RRDs or RTs. Eyes with a prior history of RRD or RT and patients 40 years of age or older at the time of cataract surgery were excluded. Risk factors for developing an RRD or RT in patients were analyzed using multivariate logistic regression analysis.
Outcomes
Approximately 3 million eyes of 2 million patients met inclusion criteria. The incidence of RRD was 0.21%, and the incidence of RT was 0.17%; the most significant risk factor for both was the presence of lattice degeneration (OR 10.53 and 43.86, respectively). Other risk factors (for RRD specifically) included male gender (OR 3.15), age 70 years or younger (OR 8.61), hypermature cataract (OR 1.61), complex cataract surgery CPT code (OR 1.52), presence of posterior vitreous detachment (OR 1.24), and high myopia (OR 1.2).
Limitations
The study is limited by the accuracy of coding, since it was not possible to review the charts. Certain risk factors (e.g., axial length and posterior capsular rupture) could not be evaluated. Furthermore, the analysis cannot determine if prophylactic laser of lattice degeneration could decrease the risk of subsequent RRD or RT.
Clinical significance
It is important to counsel patients undergoing cataract surgery that the incidence of RRD is approximately 1 in 500 within 1 year of surgery, and the risk increases to 1.4% in patients with lattice degeneration. All patients undergoing cataract surgery should be counseled on the symptoms of RRD and RT and the need for prompt evaluation should they occur.
Financial Disclosures: Dr. Ajay Kuriyan discloses financial relationships with Adverum, Annexon, National Eye Institute (Grant Support); Alimera Sciences, Allergan, Bausch + Lomb, EyePoint Pharmaceuticals, Novartis, Alcon Pharmaceuticals (Consultant/Advisor); Optos (Lecture Fees/Speakers Bureau); Lumata Health, Recens Medical (Consultant/Advisor, Private Equity/Stock Holder); Spark Therapeutics (Consultant/Advisor, Lecture Fees/Speakers Bureau); Genentech (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support).