Abstract
BACKGROUND: To evaluate the incidence and independent risk factors for rhegmatogenous retinal detachment (RRD) following cataract surgery within a single institutional cohort, with a specific focus on surgeon experience (training vs. experienced surgeons), and to contextualize findings with large-scale population-based studies. METHODS: Retrospective cohort study based on data from electronic medical records from 23,642 eyes that underwent phacoemulsification between 2018 and 2021 at a tertiary ophthalmology center, 13,294 of which were operated by training surgeons (TS) and 10,348 by experienced surgeons (ES). Postoperative outcomes were assessed within a fixed follow-up period of up to 12 months. Variables included surgeon experience, age, sex, high myopia (HM), and lattice degeneration (LD). Eyes with HM + LD were analyzed descriptively but excluded from multivariable modeling due to collinearity. Exclusion criteria: patients aged < 40 years, previous RRD, tractional or exudative retinal detachment, diabetic retinopathy, and intraoperative posterior capsule rupture. Firth’s penalized logistic regression was used to identify independent risk factors for RRD. RESULTS: Among all included eyes, 16 (0.07%) developed RRD within one year after cataract surgery, including 14 (0.11%) among TS and 2 (0.02%) among ES. A significantly higher adjusted risk for TS (OR: 5.67; 95% CI: 2.49–12.92; p < 0.001). Adjusted analysis confirmed HM (OR 12.04; 95% CI 4.25–34.09; p < 0.001) and LD (OR 12.78; 95% CI: 3.58–45.65) as strong independent risk factors. Male sex showed a modest but statistically significant association with RRD (adjusted OR 1.92; 95% CI 1.03–3.57; p = 0.039). Age showed a heterogeneous association with RRD: compared with patients < 60 years, those aged ≥ 70 years had significantly lower adjusted odds, whereas no significant difference was observed for the 61–70-year group. CONCLUSIONS: Surgeon experience is an independent and clinically relevant determinant of RRD risk after cataract surgery, even in uneventful procedures. This study represents the first single-center analysis including more than 20,000 eyes to isolate the impact of surgical experience within a standardized institutional setting while controlling for key ocular and demographic factors. These findings highlight the importance of structured supervision and training strategies to mitigate postoperative retinal complications, particularly in high-risk eyes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40942-025-00793-z.