Update on a long-term, prospective study of capsulotomy and retinal detachment rates after cataract surgery

Purpose: To evaluate the retinal detachment risks and neodymium:YAG (Nd:YAG) capsulotomy rates associated with different cataract approaches and intraocular lens (IOL) styles in a long-term, prospective clinical study. Setting: Clinical practice of 1 ophthalmologist, Felt Collins, Colorado, USA. Methods: Prospectively studied were surgical approach, date, and complications; IOL type; axial length; patient age and sex; Nd:YAG capsulotomy and date; and retinal detachment and date. Results: Phacoemulsification had a lower risk of retinal detachment than intracapsular cataract extraction (ICCE) (0.4% versus 5.4%; P < .001) and extracapsular cataract extraction (ECCE) (0.4% versus 1.6%; P = .002), Although retinal detachment was significantly associated with Nd:YAG for ECCE (3.1% versus 1.0%; P = .01), no patient in the phacoemulsification group had a retinal detachment after an Nd:YAG treatment. Retinal detachment was strongly associated with axial length of 24.0 mm and greater (P < .001), age of 60 years or less if axial length was 24.0 mm or greater (for ECCE, P = .001; for phacoemulsification, P = .01) and sex; that is, male (for ECCE, P = .04; for phacoemulsification, P = .02). Regarding IOL styles the Surgidev B20/20 (P < .001) and AcrySof MA60 (P < .001) had significantly lower Nd:YAG rates, while the Cilco UPB 320 GS had a significantly higher Nd:YAG rate (P < .001). Conclusion: Cataract surgical approach and IOL style significantly affect Nd:YAG and retinal detachment rates. Being a man, being 60 years or younger, and especially having an axial length of 24.0 mm or greater were associated with detachment. Some Nd:YAG approaches may not put the patient at increased risk for retinal detachment. J Cataract Refract Surg 2000; 26: 1017-1021 (C) 2000 ASCRS and ESCRS.