Greater Risk of Retinal Tears after Cataract Surgery Linked to Better Preoperative VA

Karen Christopher, MD

New findings suggest patients with better overall preoperative visual acuity, eyes with longer axial length, and eyes with intraoperative complications were at an increased risk of retinal tears following cataract surgery.

The data show male patients and those aged younger than 65 years old had a higher incidence of retinal tears, compared to women and those aged 65 years and older, respectively.

“Careful counseling is important, and postoperative follow-up is advised for patients identified preoperatively as being at an elevated risk of retinal tears, given the large rate of asymptomatic retinal tears and high rate of progression to retinal detachment,” wrote study author Karen Christopher, MD, University of Colorado School of Medicine.

Christopher aimed to describe the incidence and identify risk factors for retinal tears among a patient population who underwent cataract phacoemulsification surgery. The retrospective case-control study included patients who underwent cataract phacoemulsification surgery between January 2014 and December 2019 at an academic eye center in Colorado.

By study methodology, investigators extracted information from medical chart review into a cataract outcomes database. The measurements of association and P values were determined from logistic regression models with generalized estimating equations. This accounted for some patients having 2 eyes included in the database.

They identified the main outcome measures as the diagnosis of retinal tears within 1 year after cataract surgery. Incidences of retinal tears were analyzed by demographics, comorbid medical history, ocular characteristics, surgical characteristics, and intraoperative complications.

In the overall analysis, a total of 13,007 cataract surgeries were included, of which 79 (0.6%) eyes developed retinal tears within 1 year after cataract surgery. The data show that men (0.8% vs. 0.5% [men vs women]; P = .0175) and patients aged <65 years (1.0% vs. 0.2% [age <65 years vs. age >75 years]; P = .0001) had higher incidences of retinal tears.

Moreover, the findings showed the mean preoperative best-corrected visual acuity was better for the retinal tears (logarithm of the minimum angle of resolution 0.252 vs 0.366; P = .0073). According to investigators, those with retinal tears had a higher rate of preoperative high myopia (< = -6.0 D; 1.4%) in comparison with patients with low myopia (<-1D and >-6D; 0.7%), emmetropia (<1.0 D and >-1.0D; 0.4%), and hyperopia (>1.0D; 0.2%), all P = .0006.

They additionally observed individuals with intraoperative complications had a higher incidence of retinal tears (4.2%; P <.0001). Further, the mean time from cataract surgery to retinal tears was observed to be 128 days.

The data suggest most retinal tears were symptomatic (57.0%) and located in the superior hemisphere (83.5%). Of the population, 40.5% were concurrently diagnosed with a retinal detachment.

“The multivariable model resulted in intraoperative complications, axial length, and preoperative visual acuity having the strongest association with retinal tears,” Christopher concluded.

The study, “Predictors of Pseudophakic Retinal Tears at a Tertiary Care Academic Medical Center,” was published in Ophthalmology.