Cataract Surgery Is Not Associated with Decreased Risk of Retinal Vein Occlusion

PURPOSE: To evaluate whether cataract surgery is associated with decreased risks of central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) development using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry. DESIGN: Retrospective database study of the IRIS Registry data. PARTICIPANTS: Patients in the IRIS Registry who underwent cataract surgery and 1:1 matched control participants from the IRIS Registry using a decision tree classifier as a propensity model. METHODS: Control and treatment groups initially were selected using Current Procedural Terminology codes for uncomplicated cataract surgery and other straightforward criteria. To accomplish treatment–control matching, a decision tree classifier was trained to classify patients as treatment versus control based on a set of chosen predictors for treatment, where best-corrected visual acuity and age were the most important predictors. Treatment and control participants subsequently were matched using the classifier, the visit dates, and the identifications of the practice. Cox regression was performed on the matched groups to measure the hazard ratio (HR) of retinal vein occlusion development adjusted for age, sex, race, primary insurance type, and previous diagnosis of diabetic retinopathy (DR), glaucoma, and narrow angles. MAIN OUTCOME MEASURE: The HR of retinal vein occlusion developing in patients who underwent cataract surgery compared with matched control participants. RESULTS: The HRs for CRVO and BRVO developing in patients who underwent cataract surgery compared with matched control participants who did not during the first year after either cataract surgery or baseline visit were 1.26 [95% confidence interval [CI], 1.16–1.38; P < 0.001] and 1.27 [95% CI, 1.19–1.36; P < 0.001], respectively, after controlling for age, sex, race, insurance, and history of DR, glaucoma, and narrow angles. Diabetic retinopathy was the strongest predictor associated with CRVO (2.79 [95% CI, 2.43–3.20; P < 0.001]) and BRVO (2.35 [95% CI, 2.09–2.64; P < 0.001]) development after cataract surgery. CONCLUSIONS: Cataract surgery is associated with a small increase in risk of retinal vein occlusions within the first year; however, the incidence is low and likely not clinically significant.