NEWS & OPINION EWAP SEPTEMBER 2022 57 were associated with higher risk included mechanical pupil dilation, trypan usage, corneal opacity, and pseudoexfoliation. Discussion and conclusions Overall PCR rates decreased with time and were less than 1%, consistent with the other studies in the literature.5–7 Some explanations for this decreasing trend include improvements in phacoemulsification eµuipment or techniµues during the study period as well as more eperience among the surgeons providing data. Though each year added only minimal risk, an 80-year-old would have 20% higher odds of a PCR than a 55-year-old patient. Age as a risk factor was present in most of the other studies as well. Other ocular diseases were also associated with higher risk. Diabetes has been shown as a risk factor, and other studies have specifically shown previous intravitreal injections are associated with higher risk of PCR.6,8,9 Glaucoma was shown to be significant in previous studies, but one found that exclusion of pseudoexfoliation made the findings not significant.10,11 In this study, glaucoma and pseudoexfoliation syndrome were associated with higher risk of PCR. In terms of refraction, hyperopic targets had higher risk while myopic targets had a decreased risk. Some previous studies looking at axial length did show higher PCR with shorter axial lengths, but results with myopic were more conyicting.10–12 The narrower working space would be one explanation for this association. Intraoperative difficulties were associated with higher risk. Some limitations of this study include inability to assess features not included in the database (e.g., previous intravitreal injection, use of medications that could cause yoppy iris syndrome®. The data reported here is voluntary and reported by clinics, creating the potential for underreporting. Finally, there was a significant loss of data of about 1.1 million patients, although there were no significant differences in the demographics between these groups. Overall, the data show that PCR is becoming a rarer complication, but there are preoperative and intraoperative factors that can help identify patients at greatest risk of PCR. Identifying these factors will not only help counsel patients appropriately but also help determine which patients are not appropriate for junior trainees. EWAP References 1. Taylor HR. Cataract: how much surgery do we have to do? Br J Ophthalmol. 2000;84:1–2. 2. Jaycock P, et al. The Cataract National Dataset electronic multi-centre audit of 55,567 operations: updating benchmark standards of care in the United Kingdom and internationally. Eye (Lond). 2009;23:38–49. 3. Chan E, et al. Complications of cataract surgery. Clin Exp Optom. 2010;93:379–389. 4. Segers MHM, et al. Risk factors for posterior capsule rupture in cataract surgery as reyected in the European cataract surgery. Ophthalmology. 2016;123:1252–1256. 9. Chancellor J, et al. Intraoperative complications and visual outcomes of cataract surgery in diabetes mellitus: a multicenter database study. Am J Ophthalmol. 2021;225:47–56. 10. Zetterberg M, et al. A composite risk score for capsule complications based on data from the Swedish National Cataract Register: relation to surgery volumes. Ophthalmology. 2021;128:364–371. 11. Narendran N, et al. The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye (Lond). 2009;23:31–37. 12. Zare M, et al. Risk factors for posterior capsule rupture and vitreous loss during phacoemulsification. J Ophthalmic Vis Res. 2009;4:208–12. Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2022;48:51–55. 5. Zetterberg M, et al. Cataract surgery volumes and complications per surgeon and clinical unit: data from the Swedish National Cataract Register 2007 to 2016. Ophthalmology. 2020;127:305–314. 6. Shalchi Z, et al. Risk of posterior capsule rupture during cataract surgery in eyes with previous intravitreal injections. Am J Ophthalmol. 2017;177:77–80. 7. Day AC, et al. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications. Eye (Lond). 2015;29:552–560. 8. Lee AY, et al. Previous intravitreal therapy is associated with increased risk of posterior capsule rupture during Risk factors for posterior capsule rupture in cataract surgery as reƃected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery Segers MHM, et al. J Cataract Refract Surg. 2022;48(1):51–55. Purpose:To analyze the incidence and risk factors of posterior capsule rupture (PCR) in cataract surgery Setting: European clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) Design: Retrospective cross-sectional register-based study Methods: Data was obtained from the EUREQUO. The database contains data on demographics, comorbidities, and intraoperative complications, including PCR for the study period from January 1, 2008, to December 31, 2018. Univariable and multivariable logistic regression analyses were performed to estimate the (adjusted) odds ratio (OR) and x¯ confidence intervals I®. Results: Data was available for 2,853,376 patients, and 31,749 (1.1%) cataract surgeries were complicated by a PCR. The PCR rate ranged from 0.60–1.65% throughout the years, with a decreasing trend (p <0.001). The mean age of the PCR cohort was 74.8±10.5 years, and £Ç,ÈÓ xx.x¯® patients were female. Risk factors most significantly associated with PCR were corneal opacities (OR 3.21, 95% CI 3.02– 3.41, p <0.001), diabetic retinopathy (OR 2.74, 95% CI 2.59–2.90, p <0.001), poor preoperative visual acuity (OR 1.98, 95% CI 1.88–2.07, p <0.001), and white cataract (OR 1.87, 95% CI 1.72–2.03, p <0.001). Conclusions: Risk factors for P R were identified based on the EUREQUO, and the incidence of this complication is decreasing over time.
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