NEWS & OPINION 56 EWAP SEPTEMBER 2022 by Jasdeep Sabharwal, MD, PhD, and Fasika Woreta, MD Contact information Sabharwal: jsab@jhmi.edu Woreta: fworeta1@jhmi.edu Review of ‘Risk factors for posterior capsule rupture in cataract surgery as reƃected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery’ In this large database analysis of 2.8 million patients who underwent cataract surgery, annual posterior capsular rupture (PCR) rate decreased from 1.44% in 2008 to 0.6% in 2018. The major risk factors for PCR included male sex, older age, glaucoma, diabetic retinopathy, worse initial visual acuity, and a hyperopic target. Intraoperative factors such as small pupil, white cataract, corneal opacities, and pseudoexfoliation were also associated with higher rate of capsular rupture. Introduction Cataract surgery is one of the most commonly performed surgery worldwide.1 Though cataract surgery is extremely safe, understanding the rates and risk factors for the various complications is important to counsel patients and take action to prevent them.2 PCR may occur during cataract surgery and is associated with an increased risk of complications such as cystoid macular edema and retinal detachment. Risk factors for PCR in the literature include pseudoexfoliation, previous intravitreal injections, small pupils, older age, and high myopia.3 In this report, Segers et al. sought to identify risk factors by using a large, multi-national, ophthalmology specific database to study the rate and risk factors for PCR.4 Design and methods The European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) was established in 2008. It is a volunteer database where surgeons from 22 countries report consecutive cases to provide data on cataract and refractive surgery. In this report, the data obtained from 1 January 2008 to 31 December 2018 was assessed. Demographic information included in this database include age, sex, year of surgery, and laterality. The preoperative data included corrected distance visual acuity (CDVA, logMAR), target refraction. Comorbid ocular diseases were also noted, which included AMD, glaucoma, diabetic retinopathy, and other sight-threatening eye diseases. Intraoperative parameters included mechanical pupil dilation, use of trypan blue, corneal opacities, and other difficulties encountered during surgery. PCR in this study was identified as an intraoperative tear in the posterior capsule with or without zonular dialysis and vitreous loss. To assess change in PCR with time and risk factors associated with PCR the authors used logistic regression. A multivariate logistic regression was used to identify the risk factors. Results There was a total of 2,853,376 cataract surgeries included in the database during the study period. The vast majority (97%) were extracapsular cataract extraction. The average age of patients was 73.9 years (±9.7), and 58.7% were female. PCR occurred in 31,749 cases (1.1%). Among patients with PCR the average age was 74.8 (±10.5), and 55.5% were female. The annual rate of PCR ranged from 0.6% to 1.65% with a decreasing trend across the study years. Multivariate analysis was performed using variables, which were significant in a univariate analysis using a backward stepwise method. The presence of amblyopia, AMD, and previous vitrectomy were not significantly associated with a higher risk of PCR. The multivariate analysis was carried out for a total of 1,722,022 patients, and the major risk factors and the adjusted odds ratio (OR, 95% CI) were shown. Patients who were male, older, or had a diagnosis of glaucoma or diabetic retinopathy had a higher association with PCR. Worse preoperative visual acuity and a target refraction that was hyperopic had a higher association with PCR. Finally, intraoperative factors that This article originally appeared in the June 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Jasdeep Sabharwal, MD, PhD Resident Wilmer Eye Institute Johns Hopkins Medicine Baltimore, Maryland Fasika Woreta, MD Residency Program Director Wilmer Eye Institute Johns Hopkins Medicine Baltimore, Maryland
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