Original article
Late Increased Risk of Retinal Detachment After Cataract Extraction

https://doi.org/10.1016/j.ajo.2009.08.006Get rights and content

Purpose

To identify the possibility and characteristics of late increase in the cumulative risk of retinal detachment (RD) after cataract extraction and intraocular lens (IOL) implantation.

Design

Prospective cohort study of submitted claims records.

Methods

Records of 9388 consecutive insurance beneficiaries who underwent cataract extraction and IOL implantation between August 1, 1999 and December 1, 2001 were collected from the Bureau of National Health Insurance. Data included each patient's demographic characteristics, medical history, refractive status, axial length (AL), type of cataract extraction, and intraoperative complications. Posterior capsulotomy, diagnostic procedures, and treatment for retinal complications and other ocular diseases were identified by codes from physicians' billing records yearly to the end of 2007.

Results

The cumulative 8-year RD rate was 2.31% at the end of the follow-up. Factors with significant effect on the risk of RD included being male and younger, having an increased AL, and having a history of RD in the fellow eye. The cumulative risk of RD after cataract extraction and IOL implantation increased with time. There was a significantly late increased risk of RD after 4 years in the group of patients with high myopia (AL, > 26 mm; P = .026), but not in the group of moderate myopia (AL 23 to 26 mm, P = .068) or nonmyopia (AL, < 23 mm; P = .066). The late increase appeared in male group, but not in the female group, even in those with high myopia (male, P = .042; female, P = .068).

Conclusions

Our study showed that patients with high myopia may be at increased risk for late pseudophakic RD after 4 years, especially in males.

Section snippets

Methods

We performed a prospective cohort study of insurance claims and medical charts of insurance beneficiaries who underwent ECCE (including phacoemulsification) and IOL implantation at the Sixth Branch of the Bureau of National Health Insurance of Taiwan between August 1, 1999 and December 1, 2001. Each patient was identified with a coded number in the Bureau of National Health Insurance databank (to which we did not have access) and no invasive procedures were involved. Data from these charts,

Results

A total of 9388 cases were collected, including 5235 females and 4153 males. One thousand and eighty-four cases were counted as lost to follow-up before the end of the study, including those who experienced other intraocular procedure unrelated to RD repair (n = 44) or those who died during follow-up (n = 1,040). The age of patients ranged from 18 to 99 years, with a mean of 65.96 ± 9.33 years. Mean follow-up time was 79.21 ± 15.56 months (range, 5.1 to 103.3 months). The mean age was 65.84 ±

Discussion

Myopia is a common ocular condition, especially in Asia.20, 21 In Taiwan, a national survey revealed that subjects aged 16 to 18 years have a rate of myopia of 84%.20 The prevalence of high myopia is 18% among young Taiwanese males and 24% among young Taiwanese females.20, 22 Myopia poses a significant public health problem because it is associated with an increased risk of such profound ocular diseases as glaucoma, cataract, RD, and macular degeneration.1, 2, 3, 4, 5, 6, 7 Both myopia and

Shwu-Jiuan Sheu, MD, is the Chair, Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, and associate professor, National Yang-Ming University, Taipei, Taiwan. She received residency training in Ophthalmology in Taipei Veterans General Hospital, Taipei, Taiwan from 1984 to 1988 and fellowship in Doheny Eye Institute, University of Southern California, Los Angeles, California from 1992 to 1993. Her research interests are ocular neovascularization, oxidative stress in

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