Axial length as a risk factor for pseudophakic rhegmatogenous retinal detachment: A Danish registry study

Purpose: To examine axial length as a risk factor for pseudophakic rhegmatogenous retinal detachment (pRRD). Methods: We identified eyes that underwent phacoemulsification between 2 May 2002 and 10 November 2023 and had an axial length registered at the Departments of Ophthalmology in the Capital Region of Denmark or the private clinic Scandinavian Eye Center. The exposure was axial length, and the outcome was time from phacoemulsification to the occurrence of pRRD. The cumulative incidence of pRRD was estimated with the Aalen-Johansen estimator. Results: We included 129 362 eyes from 75 316 individuals; 601 eyes developed a pRRD. The eyes were distributed in groups based on axial length: <24 mm: 84 226, 24–25 mm: 38 331 and ≥26 mm: 6805. The hazard of pRRD increased with axial length, and this association was most pronounced in males. Compared to female eyes with an axial length of <24 mm (reference), male eyes of ≥26 mm had a higher hazard of pRRD (hazard ratio (HR) 16.3; 11.8–22.5), and likewise for female eyes of ≥26 (HR: 5.2; 3.3–8.1) after adjustment for age and including an interaction between axial length and sex. The 5-year cumulative incidence of pRRD among male eyes of ≥26 mm undergoing phacoemulsification between the ages 40 and 59 was 9.40% (95%CI: 7.10–12.50), and among male eyes aged ≥60 and of ≥26 mm it was 2.00% (95%CI: 1.50–2.70). Conclusions: The risk of pRRD increased with axial length, and this association was most pronounced in male eyes. The risk of pRRD was high among male eyes that underwent phacoemulsification between ages 40 and 59.