Retinal re-detachment risk significant in cataract patients who underwent vitrectomy
Key takeaways:
- Retinal re-detachment after cataract extraction can still occur in patients who previously underwent pars plana vitrectomy.
- A study investigated prevalence, timing, outcomes and potential risk factors.
ATHENS, Greece — Retinal re-detachment following cataract extraction remains significant in patients who have previously undergone pars plana vitrectomy for retinal detachment, according to a study.
“We all know that there is an increased risk of retinal detachment following cataract surgery,” Syed Ahmed, MD, said at the ESCRS winter meeting. “The main proposed reason behind this is that we suspect that there is vitreous destabilization, and then this causes significant traction of the retina, which leads to retinal detachment. However, there is a significant research gap in eyes that have had previous pars plana vitrectomy.”
The study evaluated 7 years of data from Moorfields Eye Hospital in London. A total of 110,670 patients who underwent cataract extraction were analyzed, and 1,808 of those patients underwent previous retinal detachment repair.
“In those patients, we found a 2.4% rate of re-detachment as compared to the rest of the patients, who had only a 0.34% rate of retinal detachment occur after cataract surgery,” Ahmed said.
Patients who had retinal detachment before cataract surgery had a final visual acuity of 0.15 logMAR, while those who had retinal detachment after cataract surgery, both primary and repeat retinal detachment, had a final visual acuity of 0.5 logMAR.
Patients who had a re-detachment tended to have cataract surgery earlier than those who did not. Re-detachment often occurred a fairly long time after cataract surgery, with a mean interval of 19 months, a high variability and a maximum interval of up to 8.5 years.
Understanding the mechanism of re-detachment could provide insight into risk factors and help clinical decision-making as well as patient management.
“The vitreous is not there, so that mechanism of vitreous destabilization doesn’t really work,” Ahmed said.
There is limited literature on this topic, and what is available primarily focuses on the idea that inflammation may cause the remaining vitreous to retract, resulting in tears and retinal detachment. Interestingly, a lot of the patients analyzed in the study were white men who were highly myopic, Ahmed said.
“It’s important to identify the risk factors and also highlight these to the patients so that they know what to expect with the long-term outcomes of their surgery,” he said. “Unfortunately, there is still this assumption that, with patients who don’t have a vitreous, they shouldn’t necessarily then go on to have an increased risk of retinal detachment. However, clearly this study shows that this is not the case.”
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Ahmed S, et al. Retinal re-detachment in vitrectomised eyes following cataract surgery. Presented at: ESCRS winter meeting; Feb. 28-March 2, 2025; Athens, Greece.
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