Male sex as a risk factor for pseudophakic retinal detachment after cataract extraction in Taiwanese adults

Purpose: To investigate the role of sex in modifying risk factors for retinal detachment (RD) after cataract surgery. Design: Prospective cohort study based on medical records and insurance claims from Taiwan's Bureau of National Health Insurance (BNHI). Participants: Nine thousand three hundred eighty-eight patients who underwent extracapsular cataract extraction (CE), including phacoemulsification procedures, between August 1999 and December 2001. Methods: Medical charts and claims submitted by insurance beneficiaries who underwent CE and intraocular lens implantation were collected from the sixth branch of the BNHI. Data recorded for analysis included each patient's demographic characteristics, medical history, refractive. status, axial length (AL), type of CE, and intraoperative complications. Posterior capsulotomy, diagnostic procedures, and treatments for retinal complications and other ocular diseases were identified on the basis of codes from physicians' billing records at the end of 2005. Main Outcome Measures: Incidence of RD in the full study group and in subgroups defined by sex, age, AL, type of CE procedure, concurrent systemic diseases, presence of intraoperative complications, and subsequent posterior capsulotomy. Results: The mean follow-up time of patients at the time of analysis was 54.99 +/- 15.53 months. The rate of lost follow-up was 11.55%. Cumulative 6-year RD rates were 1.16% in the full study group, 1.90% in the male subgroup, and 0.56% in the female subgroup at the end of the follow-up period. Gender distribution had a significant influence on the occurrence of RD after CE (P<0.001). Factors that were found to have a significant effect on the risk of pseudophakic RD included age under 50 years (P = 0.002), AL (P<0.001), and history of RD (P = 0.003). Surgical types (extracapsular vs. phacoemulsification) were not correlated significantly with RD, and neither were such systemic diseases as diabetes and hypertension. Subgroup analysis indicated that the significance of age, AL, and history of RD as risk factors persisted in the male subgroup but not in the female subgroup. Conclusions: The impact of axial myopia, age, and RD history as risk factors for pseudophakic RD was seen predominantly in males.