Nearly Half of Phakic Eyes Need Cataract Surgery within Two Years of PPV, National Study Shows

Phakic patients undergoing pars plana vitrectomy—especially for retinal detachment, macular hole or epiretinal membrane—should be counseled on the significant risk of cataract surgery within two years following the procedure. Photo: Wikimedia Commons. Click image to enlarge. It’s known that pars plana vitrectomy (PPV) can promote cataract progression in phakic eyes, likely due to an increase in vitreous oxygen tension after the procedure. Incidence and risk factors vary across reports, so researchers recently leveraged the Intelligent Research in Sight (IRIS) registry to help answer two questions: How likely is cataract surgery after PPV in phakic eyes, and which patients are most at risk?The retrospective cohort analysis, whose findings were published last week in Ophthalmology Retina, included 181,540 eyes of 169,184 adult patients (≥18 years) who underwent PPV from 2013 to 2022. All eyes were confirmed phakic at the time of vitrectomy. Those that underwent PPV more than once were excluded, as were eyes that didn’t meet the requirements of a minimum three-month follow-up period and a six-month look-back period. The primary outcome measure was the probability of cataract surgery at two years after PPV, since “numerous studies have found that most cataract progression occurs within this period,” the authors noted.The data showed that nearly half (46%) of eyes underwent cataract surgery within two years after vitrectomy. Older age and baseline cataract were identified as major risk factors. The risk ratios for different age groups were as follows: 1.42 for ages 40 to 49, 2.31 for ages 50 to 59, 2.59 for ages 60 to 69, 2.28 for ages 70 to 79 and 1.41 for ages ≥80). Preexisting cataract was also a significant predictor, displaying a risk ratio of 1.81. On the other hand, diabetes appeared protective against the need for cataract surgery following PPV, which has been observed in previous studies.Surgical indication also made a clear difference: compared to standard vitrectomy, vitrectomy for retinal detachment (RR: 1.38), macular hole (RR: 1.27) and epiretinal membrane (RR: 1.18) were significantly associated with increased risk of subsequent cataract surgery. Conversely, a reduced risk was seen in eyes that underwent vitrectomy with panretinal photocoagulation (RR: 0.90).“The probability of cataract surgery after vitrectomy is important prognostic information to provide for phakic patients undergoing vitrectomy,” wrote the authors in their paper on the study. “Within this large national cohort, we identified significant risk factors for cataract surgery to include older age, surgery for retinal detachment, macular hole, epiretinal membrane, complex retinal detachment without diabetes and baseline cataract,” they summarized. According to the authors, these risk factors may “help guide personalized counseling regarding future cataract surgery for phakic patients undergoing vitrectomy.”Click here for the journal source. Wang JC, Khurana RN, Liu L, Li C, Lum F. Cataract progression and risk factors for cataract surgery after pars plana vitrectomy in phakic eyes – an IRIS® registry analysis. Ophthalmol Ret. March 27, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.