Incidence and risk factors for retinal detachment after cataract surgery in Korea: a nationwide population-based study from 2011 to 2015

Purpose To evaluate the incidence and risk factors for retinal detachment (RD) after cataract surgery in the years 2011 to 2015 in Korea. Methods A nationwide retrospective cohort study was performed using health claim data from the Korean National Health Insurance Service (KNHIS) database. Patients over 40 years of age who underwent cataract surgery from 2011 and 2015 in Korea were retrospectively identified using Korean Electronic Data Interchange (KEDI) code and Korean Classification of Diseases (KCD)-7 code. Results A total of 2,191,510 eyes in 1,455,968 patients (58.63% female; mean age, 69.19 +/- 9.82 years) underwent cataract surgery from 2011 to 2015 in Korea and 17,351 patients experienced RD (45.4% female; mean age, 60.89 +/- 10.21 years). The 5-year cumulative risk of RD after cataract surgery was 1.19%, and 80.9% of RD occurred within 1 year after cataract surgery. In multivariate analysis, adjusted hazard ratio (HR) of RD was 1.335 [95% confidence interval (CI), 1.293-1.378] for male gender, 1.422 [95% CI, 1.371-1.475] for preoperative myopia, and 2.596 [95% CI, 2.367-2.849] for anterior vitrectomy during cataract surgery. Younger age was one of the factors highly associated with RD after cataract surgery, with HR [95% CI], 5.873 [5.527-6.240] in 40 to 54 years of age, 4.037 [3.811-4.277] in 55 to 64 years, and 2.026 [1.911-2.147] in 65 to 74 years. Adjusted HR of RD for surgery in secondary and primary healthcare centers were 0.495 [95% CI, 0.477-0.513] and 0.108 [95% CI, 0.104-0.113], respectively. Residence in non-metropolitan area and lower household income was associated with higher risk of RD. Conclusions Younger age, anterior vitrectomy for posterior capsule rupture, preoperative myopia, male gender, surgery in tertiary referral centers, residence in non-metropolitan area, and lower household income were associated with an increased risk of RD after cataract surgery. The optimal timing of cataract surgery should be determined considering patient's risk factors, and appropriate pre- and postoperative evaluation is needed to prevent RD in patients with higher risks.