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• W2155227923 abstract "In the recent article “Risk of Pseudophakic Retinal Detachment in 202 226 Patients Using the Fellow Nonoperated Eye as Reference” by Bjerrum et al,1Bjerrum S.S. Mikkelsen K.L. La Cour M. Risk of pseudophakic retinal detachment in 202 226 patients using the fellow nonoperated eye as reference.Ophthalmology. 2013; 120: 2573-2579Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar the conclusion was made that uncomplicated cataract surgery increases the relative risk of retinal detachment (RD) by the factor of 4.23. However, we find reason to doubt this conclusion. We understand the authors wanted to use the fellow, nonoperated eye as the control assuming that cataract surgery was the only causative factor leading to RD in the first eye. Recalling the fact that cataract is a bilateral disease in the vast majority of cases this study design seems to be a bit awkward. If cataract develops (rather, surgery is performed) in 1 eye only there is a high likelihood of this eye having comorbidity like trauma, previous surgery, uveitis, and other conditions that may lead both to the cataract and the RD. We do not understand why the authors did not check the incidence of RD in the second operated eye to test the hypothesis they put forward that the cataract surgeon is the only one to blame. The incidence of RD for the second operated eye must be in their registry data as well and it should be easy to check. The Danish National Patient Registry (NPR) has formed the basis of numerous epidemiologic studies and is a very powerful tool when used with care. One of the known issues is the quality of the coding and the recorded sequence of events. Because cataract surgery receives a lot of political and economic attention, there is reason to believe that the coding of this event is rather complete and perhaps more accurate than for example the coding of comorbidity or other surgical events. A serious problem is that the authors did not perform an audit of the registry-based material. It is our experience that the information recorded in the NPR is not completely accurate, and it is therefore good scientific practice to check with the medical records to correct for wrong or missing codes, wrong eye, wrong timing between RD and cataract surgery, and so on, which may give rise to erroneous conclusions. If impractical to do so for the entire national dataset, it could have been done on a local data sample in the hands of the authors. In our own NPR study on the incidence of RD following cataract surgery,2Olsen T. Jeppesen P. The incidence of retinal detachment after cataract surgery.Open Ophthalmol J. 2012; 6: 79-82Crossref PubMed Scopus (26) Google Scholar in which we found a risk of RD following cataract surgery of 2.3 relative to the natural incidence with significant risk factors like age, gender, operative complications and axial length; we were able to audit individual case records to identify several cases where the RD/vitreous surgery was actually performed before the cataract surgery, however, the NPR data showed the other way round. Moreover, 7 of a total of our verified 46 RD cases were found with a history of previous trauma and 2 cases with subluxation of the lens of unknown cause. In such unilateral conditions, we expect the preexisting condition to predispose to both the cataract and the retinal complication however the comorbidity was not registered in the NPR. The authors stated that the NPR data was searched for the sole operation code “CJE20 Phacoemulsification with implantation of an artificial lens in the posterior chamber,” assuming that this coding is an index of uncomplicated surgery. This is not the case, however. As every cataract surgeon knows, it is often possible even in case of capsular or zonular rupture with or without the loss of vitreous to implant a posterior chamber lens either on the capsular remains or as a scleral-sutured intraocular lens. We, therefore, do not believe the RD risk reported by the authors to apply to uncomplicated surgery. Risk of Pseudophakic Retinal Detachment in 202 226 Patients Using the Fellow Nonoperated Eye as ReferenceOphthalmologyVol. 120Issue 12PreviewTo study the risk of pseudophakic retinal detachment (PRD) after first-eye phacoemulsification cataract surgery in Denmark relative to the risk of retinal detachment (RD) in the patients' fellow nonoperated eyes. Full-Text PDF Author replyOphthalmologyVol. 121Issue 7PreviewWe appreciate the interest of Olsen and Jeppesen in our work.1 They raise a number of concerns. First, they do not understand why we did not check the incidence of retinal detachment (RD) in the second operated eye. The reason for this is that our study design did not allow us to do so because one of the censoring events was cataract surgery on the second eye. Full-Text PDF" @default.
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• W2155227923 title "Re: Bjerrum et al.: Risk of Pseudophakic Retinal Detachment in 202 226 Patients Using the Fellow Nonoperated Eye as Reference (Ophthalmology 2013;120:2573–9)" @default.
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• W2155227923 doi "https://doi.org/10.1016/j.ophtha.2013.12.042" @default.
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