Predictors of Pseudophakic Retinal Tears at a Tertiary Care Academic Medical Center

Abstract

Purpose: To describe the incidence and identify risk factors for retinal tears (RTs) among patients who underwent cataract phacoemulsification surgery and to describe the timing and features of the RTs.

Design: Retrospective case-control study.

Subjects: Patients who underwent cataract phacoemulsification surgery between January 2014 and December 2019 at an academic eye center in Colorado.

Methods: Information was extracted from medical chart review into a cataract outcomes database. Measures of association and P values were determined from logistic regression models with generalized estimating equations to account for some patients having 2 eyes included in the database.

Main outcome measures: The diagnosis of RTs within 1 year after cataract surgery. The incidences of RTs were analyzed by demographics, comorbid medical history, ocular characteristics, surgical characteristics, and intraoperative complications.

Results: In total, 13 007 cataract surgeries were included in the analysis, of which 79 (0.6%) eyes developed RTs within 1 year after cataract surgery. Men and patients aged <65 years had higher incidences of RTs (0.8% vs. 0.5% [men vs. women], P = 0.0175; 1.0% vs. 0.2% [age <65 years vs. age >75 years], P = 0.0001). The mean preoperative best-corrected visual acuity was better for the RT group (logarithm of the minimum angle of resolution 0.252 vs. 0.366, P = 0.0073). Patients with RTs had a higher rate of pre-operative high myopia (<=-6.0D) (1.4%) in comparison with patients with low myopia (<-1D and >-6D) (0.7%), emmetropia (<1.0D and >-1.0D) (0.4%), and hyperopia (>1.0D) (0.2%), P = 0.0006. Patients with intraoperative complications had a higher incidence of RTs (4.2%, P < 0.0001). The mean time from cataract surgery to RTs was 128 (standard deviation, 110) days. Most RTs were symptomatic (57.0%), located in the superior hemisphere (83.5%), and 40.5% were diagnosed concurrently with a retinal detachment. The multivariable model resulted in intraoperative complications, axial length, and preoperative visual acuity having the strongest association with RT.

Conclusions: Patients with better preoperative visual acuity, eyes with longer axial length, and eyes with intraoperative complications were at an increased risk of RTs after cataract surgery. Careful counseling is important, and postoperative follow-up is advised for patients identified preoperatively as being at an elevated risk of RTs, given the large rate of asymptomatic RTs and high rate of progression to retinal detachment.

Keywords: Cataract Complications; Pseudophakic Retinal Tears.