National Outcomes of Cataract Extraction: Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy

Jonathan C. Javitt; James M Tielsch; Joseph K. Canner; Margaret M. Kolb; Alfred Sommer; Earl P. Steinberg; Marilyn Bergner; Gerard F. Anderson; Eric B. Bass; Joseph Canner; Alan M. Gittelsohn; Marcia Legro; Neil R. Powe; Oliver P. Schein; Phoebe Sharkey; Donald M. Steinwachs; Debra Street; Donald Doughman; Merton Flom; Thomas Harbin; Harry Knopf; Thomas Lewis; Stephen Obstbaum; Denis O'Day; Walter Jackson Stark; Arlo Terry; C. Pat Wilkinson

doi:10.1016/S0161-6420(92)31775-0

National Outcomes of Cataract Extraction: Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy

Jonathan C. Javitt, James M Tielsch, Joseph K. Canner, Margaret M. Kolb, Alfred Sommer, Earl P. Steinberg, Marilyn Bergner, Gerard F. Anderson, Eric B. Bass, Joseph Canner, Alan M. Gittelsohn, Marcia Legro, Neil R. Powe, Oliver P. Schein, Phoebe Sharkey, Donald M. Steinwachs, Debra Street, Donald Doughman, Merton Flom, Thomas HarbinHarry Knopf, Thomas Lewis, Stephen Obstbaum, Denis O'Day, Walter Jackson Stark, Arlo Terry, C. Pat Wilkinson

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Abstract

Purpose: The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment. Methods: Cases of cataract surgery were identified from Medicare claims submitted in 1986 and 1987 and were followed through the end of 1988. Episodes of cataract surgery, posterior capsulotomy, and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records. Lifetable and Cox's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation. Results: Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987, 13,709 subsequently underwent Nd:YAG laser cap= sulotomy between 1986 and 1988. A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break. Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy (95% confidence interval: 2.89 to 5.25). Younger patient age, male sex, and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction. Conclusion: The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction. Therefore, capsulotomy should be deferred until the patient's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy.

Original language	English (US)
Pages (from-to)	1487-1498
Number of pages	12
Journal	Ophthalmology
Volume	99
Issue number	10
DOIs	https://doi.org/10.1016/S0161-6420(92)31775-0
State	Published - 1992

ASJC Scopus subject areas

Ophthalmology

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10.1016/S0161-6420(92)31775-0

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Javitt, J. C., Tielsch, J. M., Canner, J. K., Kolb, M. M., Sommer, A., Steinberg, E. P., Bergner, M., Anderson, G. F., Bass, E. B., Canner, J., Gittelsohn, A. M., Legro, M., Powe, N. R., Schein, O. P., Sharkey, P., Steinwachs, D. M., Street, D., Doughman, D., Flom, M., ... Wilkinson, C. P. (1992). National Outcomes of Cataract Extraction: Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy. Ophthalmology, 99(10), 1487-1498. https://doi.org/10.1016/S0161-6420(92)31775-0

Javitt, JC, Tielsch, JM, Canner, JK, Kolb, MM, Sommer, A, Steinberg, EP, Bergner, M, Anderson, GF , Bass, EB, Canner, J, Gittelsohn, AM, Legro, M, Powe, NR, Schein, OP, Sharkey, P, Steinwachs, DM, Street, D, Doughman, D, Flom, M, Harbin, T, Knopf, H, Lewis, T, Obstbaum, S, O'Day, D, Stark, WJ, Terry, A & Wilkinson, CP 1992, 'National Outcomes of Cataract Extraction: Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy', Ophthalmology, vol. 99, no. 10, pp. 1487-1498. https://doi.org/10.1016/S0161-6420(92)31775-0

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title = "National Outcomes of Cataract Extraction: Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy",

abstract = "Purpose: The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment. Methods: Cases of cataract surgery were identified from Medicare claims submitted in 1986 and 1987 and were followed through the end of 1988. Episodes of cataract surgery, posterior capsulotomy, and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records. Lifetable and Cox's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation. Results: Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987, 13,709 subsequently underwent Nd:YAG laser cap= sulotomy between 1986 and 1988. A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break. Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy (95% confidence interval: 2.89 to 5.25). Younger patient age, male sex, and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction. Conclusion: The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction. Therefore, capsulotomy should be deferred until the patient's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy.",

author = "Javitt, {Jonathan C.} and Tielsch, {James M} and Canner, {Joseph K.} and Kolb, {Margaret M.} and Alfred Sommer and Steinberg, {Earl P.} and Marilyn Bergner and Anderson, {Gerard F.} and Bass, {Eric B.} and Joseph Canner and Gittelsohn, {Alan M.} and Marcia Legro and Powe, {Neil R.} and Schein, {Oliver P.} and Phoebe Sharkey and Steinwachs, {Donald M.} and Debra Street and Donald Doughman and Merton Flom and Thomas Harbin and Harry Knopf and Thomas Lewis and Stephen Obstbaum and Denis O'Day and Stark, {Walter Jackson} and Arlo Terry and Wilkinson, {C. Pat}",

year = "1992",

doi = "10.1016/S0161-6420(92)31775-0",

language = "English (US)",

volume = "99",

pages = "1487--1498",

journal = "Ophthalmology",

issn = "0161-6420",

publisher = "Elsevier Inc.",

number = "10",

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TY - JOUR

T1 - National Outcomes of Cataract Extraction

T2 - Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy

AU - Javitt, Jonathan C.

AU - Tielsch, James M

AU - Canner, Joseph K.

AU - Kolb, Margaret M.

AU - Sommer, Alfred

AU - Steinberg, Earl P.

AU - Bergner, Marilyn

AU - Anderson, Gerard F.

AU - Bass, Eric B.

AU - Canner, Joseph

AU - Gittelsohn, Alan M.

AU - Legro, Marcia

AU - Powe, Neil R.

AU - Schein, Oliver P.

AU - Sharkey, Phoebe

AU - Steinwachs, Donald M.

AU - Street, Debra

AU - Doughman, Donald

AU - Flom, Merton

AU - Harbin, Thomas

AU - Knopf, Harry

AU - Lewis, Thomas

AU - Obstbaum, Stephen

AU - O'Day, Denis

AU - Stark, Walter Jackson

AU - Terry, Arlo

AU - Wilkinson, C. Pat

PY - 1992

Y1 - 1992

N2 - Purpose: The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment. Methods: Cases of cataract surgery were identified from Medicare claims submitted in 1986 and 1987 and were followed through the end of 1988. Episodes of cataract surgery, posterior capsulotomy, and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records. Lifetable and Cox's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation. Results: Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987, 13,709 subsequently underwent Nd:YAG laser cap= sulotomy between 1986 and 1988. A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break. Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy (95% confidence interval: 2.89 to 5.25). Younger patient age, male sex, and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction. Conclusion: The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction. Therefore, capsulotomy should be deferred until the patient's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy.

AB - Purpose: The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment. Methods: Cases of cataract surgery were identified from Medicare claims submitted in 1986 and 1987 and were followed through the end of 1988. Episodes of cataract surgery, posterior capsulotomy, and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records. Lifetable and Cox's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation. Results: Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987, 13,709 subsequently underwent Nd:YAG laser cap= sulotomy between 1986 and 1988. A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break. Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy (95% confidence interval: 2.89 to 5.25). Younger patient age, male sex, and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction. Conclusion: The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction. Therefore, capsulotomy should be deferred until the patient's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy.

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National Outcomes of Cataract Extraction: Increased Risk of Retinal Complications Associated with Nd.-YAG Laser Capsulotomy

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