Retina Tear Raises Detachment Risk After Cataract Surgery

About 1 in 20 people who have had a laser procedure to patch a retinal tear will have another retinal tear or, worse, a retinal detachment after they have cataract surgery, an analysis of a large electronic health record database has found.

The study included 1738 eyes in the Epic Cosmos database that had retinal tears before having cataract surgery. “The incidence was about 5.3% for a secondary retinal event,” said Basil Williams, MD, a vitreoretinal surgeon at Bascom Palmer Eye Institute in Miami, while presenting study results at the American Society of Retina Specialists (ASRS) 2025 Annual Meeting in Long Beach, California.

That figure is more than five times greater than the overall risk for retinal detachment after cataract surgery, which a 2015 study reported at about 1%.

“Possibly waiting 6 months in between retinal tear and cataract surgery might reduce the risk significantly,” Williams said.

The study looked only at retinal tears in eyes that had not had previous cataract surgery, a condition known as phakic retinal tears. Left untreated, a retinal tear could progress to a retinal detachment, in which retinal fluid enters under the retina surface and causes the retina to pull away from the retinal pigment epithelium, the underlying structure from which the retina gets its blood supply. A retinal detachment can lead to vision loss.

The study participants who had a previous retina tear were treated with laser before cataract removal, including people who had vitreoretinal surgery at the time of the cataract procedure, Williams said.

Men in the study had a 25% greater risk for a retinal event after cataract surgery, and people of Asian ancestry had a greater risk than other patients, possibly because of higher rates of myopia in the Asian population, Williams reported.

People who had multiple retinal tears before cataract surgery had almost three times the rate of retinal events than those with one retinal tear, Williams said. Patients who had waited more than 6 months between repair of the retinal tear and cataract surgery had about half the risk for retinal events as those who had cataract surgery sooner.

Patients who developed a retinal detachment after cataract surgery were, on average, 64 years old at the initial diagnosis of the tear compared with 67 years for those who had a recurrent retinal tear after cataract surgery. The former group was also 3 years younger when they had cataract surgery: 66 vs 67 years, Williams reported.

Mrinali Gupta, MD, a vitreoretinal surgeon at Retina Associates of Orange County in Laguna Hills, California, noted the importance of the time interval between laser surgery to repair retinal tears and cataract surgery. “The study found that the risk of subsequent retinal break was approximately 40% lower when the time interval between phakic retinal tear treatment and cataract surgery was 6 or more months,” Gupta told Medscape Medical News.

A strength of the study was the large number of eyes included in the analysis, Gupta said, but its retrospective nature and reliance on registry data limit the strength of the findings.

“Based upon this study, ophthalmologists may consider referring patients with recently treated phakic retinal tears for a detailed, dilated retinal examination prior to cataract surgery and consider recommending delaying cataract surgery until at least 6 months post-treatment of phakic retinal tears,” she added.

Williams reported having financial relationships with DORC International and Alcon. Gupta reported having financial relationships with Carl Zeiss and Alcon.

Richard Mark Kirkner is a medical journalist based in Philadelphia.