Patients with a history of retinopathy of prematurity (ROP) face a significantly higher risk of retinal tear or detachment following cataract surgery compared to the general population, according to new findings from a large IRIS Registry analysis presented at the 2025 American Society of Retina Specialists (ASRS) annual meeting in Long Beach, California.
Nikhil K. Bommakanti, MD, who conducted the research while a vitreoretinal surgery fellow at Wills Eye Hospital in Philadelphia, reported that 13.8% of eyes with a history of ROP developed a retinal tear, retinal detachment, or both within 3 years of cataract surgery. The data were drawn from the IRIS Registry and included 1,538 eyes of 1,182 adult patients who underwent cataract surgery between January 1, 2013, and December 31, 2019.
“This confirms what many of us have suspected,” said Dr. Bommakanti. “ROP eyes appear to have a much higher rate of these complications after cataract surgery than the general population.”
Figure 1. Retinal complications after cataract surgery were significantly more common in eyes with ROP, with 5.0% developing a retinal tear and 10.5% a detachment within 3 years—far exceeding rates seen in the general population.
Among the ROP cohort, 5.0% of eyes developed a retinal tear and 10.5% developed a retinal detachment within the 3-year period following cataract surgery. That rate is markedly higher than rates reported in large population-based studies, where the incidence of retinal tear is approximately 0.17% within 1 year, and the incidence of detachment ranges from 0.21% to 0.99% within 5 years (Figure 1). The study’s 13.8% overall incidence is lower than the 23% rate reported in the last major study of 66 ROP eyes undergoing cataract surgery, published in 2008 (Figure 2).
Figure 2. The incidence of retinal tear or detachment following cataract surgery measured in this study are lower than in older studies, Dr. Bommakanti noted.
Roughly one-third of the eyes in the study underwent cataract surgery before age 50, consistent with known associations between ROP and early cataract formation. The study also found a 17.2% rate of complex cataract surgery, compared to 6.3% in the general IRIS Registry population. “We think this provides useful information to cataract surgeons and retina specialists,” observed Dr. Bommakanti. “These eyes are more likely to have complicated anatomy, possibly due to high myopia or prior retinal or glaucoma surgery.”
Younger age (18 to 49 years) was an independent risk factor for both retinal tear and detachment. Other demographic factors—such as race, ethnicity, and insurance type—were not significantly associated with higher risk. Male gender and residence in the Midwest were associated with increased risk in the multivariable analysis, though Dr. Bommakanti cautioned against overinterpreting those findings due to sample size limitations.
ROP was staged in less than half the eyes, limiting the ability to analyze outcomes by disease severity. However, 11% of eyes that developed complications had a recorded history of only stage 0 or stage 1 ROP. That finding, Dr. Bommakanti said, underscores the need for clinicians to ask about ROP history and perform careful retinal examinations. “The findings can be subtle,” he said. “Some patients may not know they had ROP or may not remember to tell us unless we ask.”
Lattice degeneration was found to be significantly associated with both retinal tear and detachment. It was present in 24% of eyes that developed one of these complications, compared to 9% in eyes that did not.
The study used data from the IRIS Registry, which now includes more than 70 million unique patients. However, Dr. Bommakanti acknowledged several limitations inherent in large database studies, including missing clinical details such as birth history, gestational age, or exam findings that could have strengthened risk stratification. “We didn’t have ROP staging for over half the eyes, and there are several centers, notably some academic centers where these patients may be cared for, which aren’t included in the database,” he said.
Despite those limitations, the study represents the largest analysis to date of retinal complications after cataract surgery in adults with a history of ROP (Figure 3). Dr. Bommakanti, who will begin a position this fall as an assistant professor of ophthalmology at Tufts University in Boston, said that he hopes it will inform clinical decision-making across specialties. “This gives cataract surgeons and retina specialists more information to guide preoperative counseling, postoperative management, and overall expectations,” he said. “It’s one step forward, but there’s definitely more work to be done.” RP
Figure 3. Advances in neonatal care and ROP management have led to more individuals with ROP surviving into adulthood and eventually requiring cataract surgery. As a result, further research is needed, noted Dr. Bommakanti.