Retinal detachment following primary cataract surgery performed on olmsted county residents from 1980 through 1994

Purpose: Few assessments of postoperative rhegmatogenous retinal detachment (PRRD) following primary cataract extraction have been performed in non-referral practices with defined populations. We evaluated the frequency of this complication, as well as risk factors associated with its occurrence in a geographically circumscribed population. Methods: Using Rochester Epidemiology Project databases which capture virtually all medical care provided to residents of Olmsted County, Minnesota, we identified all primary cataract extraction procedures performed from 1980 through 1994 on documented county residents. Accuracy of coded demographic and clinical data was verified by review of sample records. All cases of PRRD were identified through record review. Using Kaplan-Meier survival analysis and univariate Cox proportional hazards models, we evaluated PRRD risk among cataract extraction patients overall, and stratified on sex, age, year of surgery, use of intracapsular, extracapsular or phacoemulsification procedure, and presence or absence of intraocular lens implantation. Small numbers precluded multivariate modeling of confounding or interactions among variables. Results: Preliminary data on 3,473 extractions (with up to 16.8 years postoperative follow-up; median follow-up=4.5 years) identified 27 cases of PRRD. Cumulative probabilities of PRRD (with 95% confidence intervals) ai 6, 24 and 60 months were 0.2% (0.1-0.4%), 0.4% (0.2-0.6%) and 0.7% (0.4-1.0%) respectively. The median interval from surgery to diagnosis was 35 months; 26% of cases occurred within 6 months, 44% were seen within 2 years, and 70% were seen within 5 years. PRRD was nearly 3 times as likely among males as among females (p=.014), and nearly 4 times as likely among patients <65 years of age as in patients >65 (p<.00l). Calendar year, procedure performed and implant use were not associated with increased risk. Conclusions: PRRD is rare following primary cataract extraction performed in a general population. Fewer than half the observed cases occur within two years postoperatively. Males and younger patients appear to be at higher risk.