A 5-Year Audit of Cataract Surgery Outcomes After Posterior Capsule Rupture and Risk Factors Affecting Visual Acuity

• Published in: American journal of ophthalmology Vol. 157; no. 1; pp. 180 - 185.e1
• Main Authors: Ti, Seng-Ei, Yang, You-Nian, Lang, Stephanie S, Chee, Soon Phaik
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2014; Elsevier Limited
• Subjects: Age; Aged; Audits; Cataracts; Clinical Competence; Eye surgery; Faculty, Medical - statistics & numerical data; Female; Humans; Internship and Residency - statistics & numerical data; Intraoperative Complications; Lens Implantation, Intraocular; Logistics; Male; Medical Audit; Middle Aged; Ophthalmology; Ophthalmology - statistics & numerical data; Phacoemulsification - statistics & numerical data; Posterior Capsular Rupture, Ocular - epidemiology; Posterior Capsular Rupture, Ocular - physiopathology; Postoperative Complications; Retrospective Studies; Risk Factors; Singapore - epidemiology; Success; Surgery; Treatment Outcome; Visual Acuity - physiology; Singapore
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2013.08.022

Purpose To describe the posterior capsule rupture rates and visual outcomes after phacoemulsification, analyze risk factors for poor vision, and compare results of faculty (F) and residents (R). Design Retrospective audit study. Methods Visual success of all capsule ruptures (2006-2010) was analyzed and compared to uneventful cases. Rupture rates of faculty and residents were compared (χ², P < .05). Success was defined as % best-corrected visual acuity (BCVA) ≥20/40 at 3 months (excluding poor-prognosis eyes) and studied in relation to age, sex, surgeon type, stage of surgery, vitreous loss, dropped nucleus, and other complications (eg, retinal detachment, corneal decompensation, dislocated intraocular lens [IOL]). Final risk factors were identified using multivariate logistic regression analysis. Results From 2006 to 2010, there were 887 capsule ruptures in 48 377 phacoemulsification cases (rate 1.8%). Uneventful cases had significantly better visual outcomes than capsule ruptures (98.5% vs 93.9%; P  < .01). Faculty rupture rates were lower (F = 1.4%) than residents' (R = 3.4%; P < .01), but visual outcomes were similar (F = 93.8%, R = 93.7%; P > .05). Ruptures most frequently occurred during phacoemulsification (59.6%) and irrigation and aspiration (24.8%) stages. Risk factors for poor outcomes included age >65 years, dropped nuclei, and other complications. Conclusion The overall capsule rupture rate was 1.8%. Although residents had higher rates, visual success matched faculty's, possibly attributable to case mix and close supervision. Associated risk factors for poor vision included age >65 years, dropped nuclei, and postoperative retinal, corneal, and IOL complications.