Detached Retina—A Serious Complication that Requires Immediate Attention

If you're having cataract surgery, you're in good company. It's the most frequently performed operation in the United States and is especially common for people over age 65. It is a very safe procedure, and complications are rare. However, about 1 to 2 percent of people who undergo cataract surgery will experience a retinal detachment—a serious condition that requires prompt medical attention.

What Is Retinal Detachment?

In a normal eye, the retina, a thin, light-sensitive layer of nerve tissue lining the back of your eye, presses up against an underlying layer of cells known as the retinal pigment epithelium (RPE). But sometimes the retina can become detached from the RPE in a manner similar to peeling wallpaper.

What causes the detachment? Most commonly, a hole, tear, or break in the retina enables fluid from the vitreous humor to seep in under the retina, causing it to separate from the RPE. A less frequent cause of retinal detachment is scar tissue on the surface of the retina that contracts, causing the retina to pull away from the underlying cells.

In some cases, fluid leaks into the area underneath the retina, even though there are no retinal tears or breaks. In the setting of cataract surgery, it is believed that most retinal detachments begin with a separation of the vitreous gel from the surface of the retina. This vitreous detachment occurs frequently and is benign, except in those cases where the separation of the vitreous causes a small tear or hole in the retina. Fluid can then enter through the holes and elevate or detach the retina.

Risk Factors for Retinal Detachment following Cataract Surgery

The greatest risk of retinal detachment after cataract surgery occurs among people who are also very nearsighted. Even in the absence of cataract surgery, being very nearsighted is the principal risk factor for retinal detachment. This is because the peripheral retina is thinner and less well attached in individuals with very long, nearsighted eyes. Intraoperative complications of cataract surgery also can increase the risk of retinal detachment. Capsule-related complications, such as lens remnants left in the vitreous humor during cataract surgery, can raise the risk as well.

Although cataract surgery—or any eye surgery—and extreme nearsightedness are risk factors for retinal detachment, other factors also can impact your risk.

Race and gender. Men are more likely than women and whites are more likely than blacks to have a retinal detachment.

Family history. Having a firstdegree relative (mother, father, or sibling) who has had a retinal detachment makes it more likely that you will have one as well.

Previous retinal detachment. People who have had a retinal detachment in one eye are at increased risk for having the problem in the other eye.

Other eye-health problems. Eye tumors, diabetic retinopathy, and sickle cell retinopathy are associated with an increased risk.

Eye injury. Retinal detachment can result from trauma to the eye.

Publication Review By: Susan B. Bressler, M.D., Harry A. Quigley, M.D., Oliver D. Schein, M.D., M.P.H.

Published: 24 Feb 2011

Last Modified: 04 Nov 2014