We reviewed the medical records of 1,726 eyes consecutively operated on with extracapsular cataract extraction to examine the incidence of and the risk factors for retinal detachment (RD). In Denmark, both diagnoses and deaths are registered centrally; therefore, a complete follow-up was achieved in each case and actuarial statistical methods were used in the risk assessment. Seven eyes (0.41%) developed RD and 345 eyes (20.0%) had YAG-laser capsulotomy in the observation period, which averaged 39 months. We identified the following risk factors for RD: age less than 70 years at the time of surgery, intraoperative complications, axial length > or = 25 mm. Nonsignificant factors included male gender and postoperative complications. One eye (0.29%) developed RD following YAG-laser capsulotomy. We concluded that the high risk of RD is concentrated in a small group of myopic patients who have cataract surgery when they are less than 70 years of age. Our results do not suggest a causal relationship between YAG-laser capsulotomy and subsequent RD.

We reviewed 604 eyes in 521 patients who had intracapsular cataract extraction. The follow-up period averaged 39 months. The incidence of rhegmatogenous aphakic retinal detachment (ARD) was 1.3% in the whole group. The ARD incidence was 1.0% in eyes without surgical complications and 5.4% in myopic eyes (myopia defined as an aphakic refraction less than or equal to +9.0 diopters). The log-rank test was used to estimate the statistical significance of various ARD predictors. Significant predictors were age at surgery below 70 years (P = .0004) and myopia (P = .001). Our results indicate that the high risk of ARD is concentrated in a small group of myopic patients operated on at a relatively early age. During the follow-up period, 128 patients died. Compared with the mortality rate of the entire Danish population, this was not an above average mortality rate. Thus, our results do not support the hypothesis that senile cataracts reflect general systemic deterioration rather than local eye disease.

Morphological changes and lens position were examined in 51 eyes of 51 patients 25 to 37 (mean 31) months after extracapsular cataract extraction with implantation of a posterior chamber lens in the ciliary sulcus. Ocular morphology was compared to a previously published examination of the same eyes performed 4 months after surgery. The anterior chamber depth, lens position and the position of the posterior lens capsule had remained unchanged. 'Iris bulging', i.e. a gonioscopically visible slight impression of the iris overlying the lens haptics, had increased from 0 to 42%, iridal transillumination defects from 34 to 46%, and pigment dispersion in the chamber angle from 46 to 72%. Twenty-four percent of the eyes had developed significant, capsulotomy-requiring opacification of the posterior lens capsule. We draw the following conclusions: The posterior chamber lens and the posterior lens capsule have reached their permanent positions by the fourth post-operative month. Implantation of a posterior chamber lens in the ciliary sulcus constitutes a constant stimulus for structural changes of the iris with subsequent dispersion of pigment on neighbouring ocular structures.

In 1984, our ophthalmology department switched from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE). We reviewed the postoperative incidence of retinal detachment (RD) in two consecutive series: (1) 604 eyes operated on by ICCE from 1982 to 1983 and (2) 1726 eyes operated on by ECCE from 1985 to 1986. Follow-up averaged 39 months in both groups. The RD incidence was 1.30% after ICCE and 0.41% after ECCE, a statistically significant difference. In both groups, the risk of RD was high for patients less than 70 years of age at the time of surgery but minimal for patients older than 70 years. The proportion of younger patients was significantly higher in the ICCE group (29.5%) than in the ECCE group (23.2%). When the data were stratified by age and the difference in age composition adjusted for statistically, the difference between the two groups in the incidence of postoperative RD was less pronounced. We conclude that although not significant at the 5% level after adjusting for age distribution, our results suggest a decreased risk of RD with ECCE.

We followed two comparable groups of patients operated on for cataract immediately before and after a transition from intracapsular extraction with an anterior chamber lens to extracapsular technique with a posterior chamber lens. Both groups consisting of 69 eyes of 69 patients were invited to follow-up examinations 4 months and 2 1/2 years after surgery. The visual acuity was similar in the two groups at the two follow-up examinations. Significantly more eyes in the intracapsular group showed either a rise in intraocular pressure or received anti-glaucomatous medications at the latest follow-up. YAG-laser capsulotomy had been performed in 14.5% of the 69 extracapsularly operated eyes. There was a trend towards more intra-operative and cumulative post-operative complications in the intracapsular group, but this difference was not statistically significant. We conclude, that both intracapsular and extracapsular cataract extraction are followed by such low incidences of post-operative complications, that it will require a very large number of eyes to confirm or reject a possible statistically significant difference in post-operative complication rate.