Cataract Progression and Risk Factors for Cataract Surgery after Pars Plana Vitrectomy in Phakic Eyes

Purpose To investigate the probability of cataract surgery after pars plana vitrectomy (PPV) in phakic eyes using the IRIS® Registry (Intelligent Research in Sight) and to identify risk factors for subsequent cataract surgery. Design Retrospective cohort analysis from the IRIS Registry. Subjects A total of 181 540 eyes of 169 184 patients underwent PPV from July 1, 2013 to September 30, 2022. Methods Adult patients aged 18 or older were included. To ensure that eyes were phakic at the time of vitrectomy, eyes with a prior diagnosis of pseudophakia or aphakia or those that underwent prior or concurrent cataract surgery or lensectomy were excluded. Eyes that underwent more than 1 vitrectomy were also excluded, and a minimum follow-up period of 3 months and look-back period of 6 months were required. Multivariable regression analyses were performed to assess risk factors for cataract surgery. Main Outcome Measures Probability of cataract surgery within 2 years after PPV. Results The overall probability of cataract surgery within 2 years after PPV was 46%. On multivariable modified Poisson regression, major risk factors for cataract surgery included older age compared with age <40 years (relative risk [RR] = 1.42; 95% confidence interval [CI], 1.32–1.54, P < 0.001 for ages 40–49; RR = 2.31; 95% CI, 2.16–2.48 for ages 50–59; RR = 2.59; 95% CI, 2.42–2.78 for ages 60–69; RR = 2.28; 95% CI, 2.13–2.45 for ages 70–79; RR = 1.41; 95% CI, 1.30–1.52 for age ≥ 80 years), as well as baseline cataract (RR = 1.81; 95% CI, 1.78–1.84), whereas diabetes had a protective association (RR = 0.83; 95% CI, 0.82–0.85). Compared with standard vitrectomy, vitrectomy for retinal detachment (RR = 1.38; 95% CI, 1.35–1.42), macular hole (RR = 1.27; 95% CI, 1.24–1.31), and epiretinal membrane (RR = 1.18; 95% CI, 1.14–1.21) was significantly associated with an increased risk of cataract surgery, whereas vitrectomy with panretinal photocoagulation (RR = 0.90; 95% CI, 0.87–0.93) was significantly associated with a decreased risk of cataract surgery. Conclusion In this national database, approximately half of phakic patients undergoing vitrectomy underwent cataract surgery within 2 years, with risk factors including age, baseline cataract, and vitrectomy for conditions related to abnormal vitreoretinal interface. Diabetes and vitrectomy with panretinal photocoagulation were protective factors. Financial Disclosure(s) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.