Retinal re-detachment after cataract surgery in myopic eyes

Paper title: Risk of Retinal Redetachment After Cataract Surgery Following Retinal Detachment Repair in Myopic and Highly Myopic Eyes

Authors: Mesfin Y (1), Arnal L (2), Salvi A (2), Wai KM (2), Brodie F (1), Koo E (2), Kossler AL (2), Koo E (2), Rahimy E (2,3), Mruthyunjaya P (2), Ludwig CA (2)

1. School of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA. 
2. Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA. 
3. Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA, USA. 

Date: Published online February 24, 2026

Reference: Mesfin Y, Arnal L, Salvi A, Wai KM, Brodie F, Koo E, Kossler AL, Koo E, Rahimy E, Mruthyunjaya P, Ludwig CA. Risk of Retinal Redetachment After Cataract Surgery Following Retinal Detachment Repair in Myopic and Highly Myopic Eyes. J Vitreoretin Dis. 2026 Feb 24:24741264261418517.

[Link to open access paper]

Myopia and cataract surgery are established risk factors for rhegmatogenous retinal detachment (RRD), particularly in eyes with prior retinal pathology. In patients who have undergone prior retinal detachment repair, many will later require cataract surgery, yet the combined impact of these factors remains unclear. This large retrospective cohort analysed 1222 patients with prior RRD repair undergoing cataract surgery, with outcomes stratified by myopia status and age to evaluate which factors influence the risk of a repeat episode of retinal detachment.

The key findings were as follows.

• No clear increase in retinal detachment risk was observed with myopia after cataract surgery, although a higher proportion of detachments occurred with increasing myopia (8.5% non-myopes, 9.5% myopes, 15.6% high myopes) 
• Overall incidence of retinal detachment after cataract surgery was 2.9% within 1 year 
• Younger patients (18–35 years) showed the highest incidence (5.3% at 1 month, 7.0% at 3 and 12 months) and were more likely to have undergone complex initial retinal detachment repairs 
• Retinal detachments occurred across both early and late post-operative periods, without a clear pattern of increased risk over time
• Single-surgery anatomical success ranged from 60.0% in high myopes to 86.7% in myopes

 This study suggests that myopia is not a key factor in determining retinal re-detachment risk after cataract surgery in patients with prior RRD repair. Instead, risk appears to be more strongly influenced by other factors, particularly patient age and the complexity of the initial retinal detachment repair. While higher levels of myopia were associated with more cases of detachment, this did not translate into a clear increase in overall risk. 

Younger patients, particularly those aged 18–35 years, demonstrated the highest incidence of retinal re-detachment after cataract surgery. This group was also more likely to have undergone complex initial retinal detachment repairs, which may contribute to their increased risk. Clinically, this highlights the importance of careful preoperative assessment and closer postoperative monitoring in younger patients, especially in the early months following surgery.

The finding that detachments occurred across both early and late postoperative periods indicates that there is no clearly defined “safe window” after surgery. Patients should be advised that risk persists beyond the immediate postoperative phase and be educated on the symptoms of retinal detachment, with clear guidance to seek urgent review if symptoms arise.

Overall, cataract surgery can be considered in patients with prior RRD repair without overemphasising myopia as a risk factor for retinal re-detachment. Instead, clinicians can adopt a more individualised approach, focusing on age, prior surgical complexity, and retinal status when planning surgery and counselling patients and manging post-operatively.

While this study provides useful insights, several questions remain regarding retinal re-detachment risk after cataract surgery in patients with prior RRD repair. The analysis relied on diagnostic and procedural coding from electronic health records to identify and track patients, which may not fully capture clinical detail. The role of myopia may therefore be more nuanced than shown here, particularly given the limited number of highly myopic patients and the absence of biometric measures such as axial length.

The relationship between younger age and increased risk also warrants further investigation. It remains unclear whether this is primarily driven by the higher prevalence of complex initial retinal detachment repairs, differences in vitreoretinal interface characteristics, or other underlying ocular factors. Better understanding these mechanisms could help identify which patients would benefit most from closer monitoring or preventative strategies.

Additionally, more detailed prospective data are needed to assess the impact of surgical techniques, including cataract surgery complexity and retinal repair methods, on long-term outcomes. The timing of re-detachment also remains an area for further study, particularly to determine whether there are identifiable periods of higher vulnerability or opportunities for targeted follow-up.

Finally, studies evaluating preventative interventions, such as prophylactic laser retinopexy in high-risk patients, and the role of detailed retinal imaging in preoperative assessment, may help refine risk stratification and improve patient outcomes.

Purpose: To describe how risk factors such as repair of rhegmatogenous retinal detachment (RRD), cataract extraction, and myopia interrelate to influence the risk of retinal redetachment.

Methods: This retrospective cohort study included patients with phakic RRD who had subsequent cataract extraction. The incidence and risk of redetachment were compared using Cox regression and χ2 analyses. Stratified analyses were performed based on time after cataract extraction, age, myopia status, and retinal repair type.

Results: Of 1222 patients identified, no significant association was found between myopia and the incidence of redetachment, although the proportion of redetachments increased with the degree of myopia (nonmyopes, 8.5%, myopes, 9.5%, high myopes, 15.6%; P = .36). Myopia and high myopia were not associated with an increased risk of redetachment over time (hazard ratio, 1.01, P = .96; hazard ratio, 1.54, P = .35, respectively). Additionally, the incidence of redetachment was not significantly correlated with the time after cataract extraction (P = .33). A significant difference was observed between the incidence of redetachment and age (P = .003). Patients between 18 and 35 years experienced the highest incidence of redetachment within 1, 3, and 12 months after cataract extraction (5.26%, 7.02%, 7.02%, respectively). Such patients were overrepresented among those who underwent complex surgeries for initial phakic RRD repair (30-39 years, residual: 2.71; 40-49 years, residual: 3.32).

Conclusions: Among patients with a phakic RRD, myopia did not significantly increase the risk of redetachment after cataract extraction. However, an upward trend was noted between the proportion of redetachments and the degree of myopia. Younger patients exhibited the highest incidence of redetachment and should be closely monitored after cataract extraction.

Link to open access paper]