Assessing RD Risk After Lens Surgery

The five-year results from the ESCRS MYOPRED study confirmed its working hypothesis that among myopic eyes undergoing cataract or refractive lens exchange (RLE) surgery, those with a complete posterior vitreous detachment (PVD) preoperatively have a lower postoperative risk of retinal detachment (RD) compared to eyes with no or an incomplete PVD.

The research, presented by Marlies Ullrich MD at the 2025 ESCRS Congress in Copenhagen, showed RD rates increased during follow-up in both the complete PVD and no/incomplete PVD groups. At 5 years, the RD rate was 0.7% in the group with complete PVD versus 5.4% in the no/incomplete PVD group. In addition, the risk of postoperative RD was significantly higher (approximately 8-fold) among males compared to females. Young age was also associated with higher RD risk.

Dr Ullrich noted that the findings have important implications for patient care.

“The MYOPRED study shows that preoperative PVD status is a useful additional parameter in estimating RD risk in myopic eyes after lens surgery and should be assessed preoperatively—ideally with optical coherence tomography (OCT) and particularly in groups with high-risk features. This information can impact selection of candidates for RLE, and it helps us inform patients more individually about their RD risk.”

“This is the first large prospective trial in only myopic eyes assessing the effect of PVD status before lens surgery on long-term RD,” project leader Oliver Findl MD told EuroTimes.

“For me, the outcome of the MYOPRED trial calls for performing OCT with a long scan through the macula and optic disc to identify PVD in myopic patients planned for lens surgery. This is relevant for the informed consent before surgery in cataract patients and for deciding whether to plan RLE or a phakic lens in myopes [hoping] to get rid of their glasses,” he said. “Sometimes we also encounter high myopes with unilateral cataract—for example, after RD surgery in one eye—and the question arises [as to] what we should do with the other eye. If the eye already has a PVD, I would proceed with RLE. Otherwise, I would suggest a phakic lens.”

MYOPRED is a prospective observational multicentre study conducted at 10 sites in 5 European countries. The ESCRS-sponsored trial included eyes with an axial length of 25 mm or greater undergoing cataract surgery or RLE. Eyes undergoing a planned combined procedure and with a previous history of RD, intraocular surgery, uveitis, or trauma, were excluded.

PVD status was mainly assessed with OCT and graded by a reading centre. The number of follow-up visits in the first postoperative year depended on PVD status, ending earlier for eyes with complete PVD preoperatively. Follow-up after the first year was conducted through a telephone interview that queried patients about whether they had an RD, intraocular surgery, or laser treatment. Reported events were verified by in-office examination or review of surgical records.

The study included 600 study eyes and 368 fellow eyes that fulfilled the inclusion criteria. Males and females were almost equally represented in the study cohort. Patients had a mean age of 65 years, with a wide range of 23 to 92 years. Median axial length was 26 mm in both study and eligible fellow eyes and ranged up to 35 mm. A majority of eyes had a complete PVD at baseline, and the rate of complete PVD was significantly higher in females versus males across all age strata.

Oliver Findl MD, MBA, FEBO is Chief of VIROS, Professor and Chair of the Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. oliver@findl.at

Marlies Ullrich MD is a medical investigator at the Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria.