Incidence and risk factors for retinal detachment after cataract surgery: a comparison between trainee and experienced surgeons

TL;DR

This study finds that trainee surgeons have a higher risk of causing retinal detachment after cataract surgery compared to experienced surgeons, especially in high-risk patients.

Contribution

This is the first single-center study with over 20,000 eyes to isolate the impact of surgical experience on retinal detachment risk after cataract surgery.

Findings

Trainee surgeons had a 5.67 times higher adjusted risk of retinal detachment compared to experienced surgeons.

High myopia and lattice degeneration were strong independent risk factors for retinal detachment.

Male sex and age over 70 were also associated with retinal detachment risk.

Abstract

To evaluate the incidence and independent risk factors for rhegmatogenous retinal detachment (RRD) following cataract surgery within a single institutional cohort, with a specific focus on surgeon experience (training vs. experienced surgeons), and to contextualize findings with large-scale population-based studies.

Retrospective cohort study based on data from electronic medical records from 23,642 eyes that underwent phacoemulsification between 2018 and 2021 at a tertiary ophthalmology center, 13,294 of which were operated by training surgeons (TS) and 10,348 by experienced surgeons (ES). Postoperative outcomes were assessed within a fixed follow-up period of up to 12 months. Variables included surgeon experience, age, sex, high myopia (HM), and lattice degeneration (LD). Eyes with HM + LD were analyzed descriptively but excluded from multivariable modeling due to collinearity. Exclusion criteria: patients aged < 40 years, previous RRD, tractional or exudative retinal detachment, diabetic retinopathy, and intraoperative posterior capsule rupture. Firth’s penalized logistic regression was used to identify independent risk factors for RRD.

Among all included eyes, 16 (0.07%) developed RRD within one year after cataract surgery, including 14 (0.11%) among TS and 2 (0.02%) among ES. A significantly higher adjusted risk for TS (OR: 5.67; 95% CI: 2.49–12.92; p < 0.001). Adjusted analysis confirmed HM (OR 12.04; 95% CI 4.25–34.09; p < 0.001) and LD (OR 12.78; 95% CI: 3.58–45.65) as strong independent risk factors. Male sex showed a modest but statistically significant association with RRD (adjusted OR 1.92; 95% CI 1.03–3.57; p = 0.039). Age showed a heterogeneous association with RRD: compared with patients < 60 years, those aged ≥ 70 years had significantly lower adjusted odds, whereas no significant difference was observed for the 61–70-year group.

Surgeon experience is an independent and clinically relevant determinant of RRD risk after cataract surgery, even in uneventful procedures. This study represents the first single-center analysis including more than 20,000 eyes to isolate the impact of surgical experience within a standardized institutional setting while controlling for key ocular and demographic factors. These findings highlight the importance of structured supervision and training strategies to mitigate postoperative retinal complications, particularly in high-risk eyes.

The online version contains supplementary material available at 10.1186/s40942-025-00793-z.