RISK-FACTORS FOR RETINAL-DETACHMENT AFTER CATARACT-SURGERY - A POPULATION-BASED CASE-CONTROL STUDY

Purpose: Previous analyses of Medicare claims data, as well as clinica l series, have suggested that performance of neodymium:YAG (Nd:YAG) la ser posterior capsulotomy after extracapsular cataract surgery increas es significantly the risk of retinal detachment. However, methodologic problems with previous research limit the strength of conclusions tha t can be drawn from these earlier studies. This study was designed to resolve those methodological limitations while using a population-base d approach for assessment of the independent association between the p erformance of Nd:YAG laser posterior capsulotomy and pseudophakic reti nal detachment. Methods: A nested case-control study was conducted. Me dicare beneficiaries who had undergone extracapsular cataract extracti on from 1988 to 1990 were identified from a 5% sample of Medicare clai ms data. Within this cohort, people who were diagnosed or treated for retinal detachment during the years 1988 through 1991 (cases) were ide ntified from Medicare records. Four controls were matched to each case of retinal detachment using an incidence density design. Providers of the patients' cataract and retinal surgery were contacted and asked t o provide clinical data for all cases and controls that they had treat ed. Results: Seven hundred six cases of retinal detachment were origin ally identified from Medicare records. After exclusions due to ineligi bility, a total of 291 cases and 870 matched controls were available f or analysis. Conditional logistic regression models showed that a numb er of factors were associated independently with an excess risk of ret inal detachment after cataract surgery. These included Nd:YAG laser ca psulotomy (odds ratio [OR] = 3.8; 95% confidence interval [Cl], 2.4-5. 9), a history of retinal detachment (OR = 2.7; 95% Cl, 1.2-6.1), a his tory of lattice degeneration (OR = 6.6; 95% Cl, 1.6-27.1), axial lengt h (OR = 1.21/mm 95% Cl, 1.03-1.43), refractive error (OR = 0.92/diopte r; 95% Cl, 0.88-0.95), and a history of ocular trauma after cataract s urgery (OR = 6.1; 95% Cl, 4.3-28.2). Conclusion: Performance of Nd:YAG , laser posterior capsulotomy is associated with a significantly eleva ted risk of retinal detachment in patients who have undergone extracap sular cataract extraction. Other independent risk factors for retinal detachment include axial length, myopia, posterior capsular rupture du ring surgery, history of retinal detachment or lattice degeneration, a nd ocular trauma after cataract surgery.