Retinal detachment incidence in refractive lens exchange versus cataract surgery: uncommon versus rare - systematic review and meta-analysis

Aims: Refractive lens exchange (RLE) is becoming a popular refractive solution for patients ineligible for corneal surgeries or phakic intraocular lenses. However, concerns regarding retinal detachment (RD) risk persist. Methods: A systematic literature review and meta-analysis was performed in Medline and Scopus.The final search was updated on 30 March 2024. Results: Of 2415 full-text screening reports, 40 studies met inclusion criteria, encompassing 8 592 380 eyes. This included 20 264 eyes that underwent RLE and 8 572 116 eyes that underwent cataract surgery. In the RLE surgery subgroup, the RD incidence for follow-up <12 months was 0.00016% (0.00000%; 0.00034%), for follow-up between 12 and 24 months was 0.0000% (0.0000%; 0.03102%), and for follow-up >24 months was 0.02312% (0.00984%; 0.03640%) (p<0.01). In the cataract surgery subgroup, the incidence for follow-up >24 months was 0.01244% (0.00655%; 0.01832%), and for missing follow-up was 0.00429% (0.00221%; 0.00637%). Conclusions: We found that the incidence of RD after RLE was approximately double that observed after cataract surgery with at least 24 months (median 4 years) follow-up. Thus, RD may be classified as rare complication after cataract surgery (1/1000) and an uncommon complication after RLE (1/500). It must be noted that the heterogeneity of the subgroups after RLE was low. While some limitations, such as the lack of long-term follow-up in certain studies and incomplete reporting of factors like axial length or PVD status, may slightly influence the interpretation, these findings provide valuable insights. Acknowledging the inherent uncertainty in interpreting these results, additional studies are recommended.