Risk of posterior capsular rupture in cataract surgery of fellow eyes
(Image credit: AdobeStock/Parilov)
A recent study found that a history of posterior capsule rupture (PCR) in the first eye that underwent cataract surgery was an independent risk factor for the occurrence of the same complication in the fellow eye during cataract surgery, according to Abdelrahman M. Elhusseiny, MD, MSc, and Ahmed Sallam, MD, PhD, FRCOphth. The investigators from the Harvey & Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, reported this finding at the 2024 American Academy of Ophthalmology annual meeting in Chicago.
“PCR is a significant complication of phacoemulsification and the most important quality metric,” they explained. In addition, the risks and rates of PCR are well defined, ranging from 1.5% to 5%.1,2 However, the effect of PCR in the first eye undergoing cataract surgery remains unknown for the fellow eye,” they explained.
Considering this gap in knowledge, they conducted a retrospective clinical database study that covered 12 years to quantify the risk of PCR in the second eye after PCR developed in the first eye during cataract surgery. The study included 8 eye centers, and included patients who underwent bilateral non-simultaneous cataract surgeries.
The factors considered were PCR in the first eye, patient demographics, diabetes mellitus, ocular pathology, and the surgeon expertise.
Analysis of clinical database
The investigators identified a total of 131,232 patients during the 12-year period. Of those, 66,288 patients (mean age, 75.3 years) who met the inclusion criteria were included in the study, for a total of 132,576 eyes.
The median time between the cataract extractions was 21 weeks. About 70% of the eyes in which PCR developed in the fellow eye had no obvious risk factor. About two-thirds of the surgeons performing the cataract surgeries in the fellow eyes were at the attending level.
The analysis showed that PCR developed during the cataract surgery in the first eye in 932 patients (1.4%) and developed in the surgery in the second eye in 1,039 patients (1.5%).
Elhusseiny and Sallam commented, “The risk of the fellow eye developing PCR in patients with first-eye PCR was higher than in patients without first-eye PCR, that is, 3.2% versus 1.5% (P < 0.001). In the fully adjusted logistic regression model, first-eye PCR continued to be a significant risk factor (odds ratio [OR] = 1.7). From the highest to the lowest OR, we discovered that zonular dialysis (OR = 5.4), advanced cataract (OR = 2.8), and pseudoexfoliation were significant risk factors.”
It is notable that when PCR develops during the surgery in the first eye, the patient’s risk of PCR development in the fellow eye increases by about 2-fold. “Some patients are at higher risk for developing PCR than others!” they emphasized.
Both tissue factors, including capsular thickness and mechanical strength, and patient factors, including head movement, deep socket, and inability to lie down can be instrumental in PCR.
Elhusseiny and Sallam concluded, “Previous development of PCR is an independent risk factor for PCR in the fellow eye, increasing risk by 2-fold. Patients should be counseled about this potential as well as the impact of surgeries performed by surgical trainees.”
References:
Grinton, M, Sandhu J, Shwe-Tim A, et al. Incidence, characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: an ophthalmology trainees’ perspective. Eye. 2021;35:1213–1220; DOI: 10.1038/s41433-020-1057-z
Day AC, Donachie PH, Sparrow JM, Johnston RL; Royal College of Ophthalmologists’ National Ophthalmology Database. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications. Eye (Lond). 2015;29:552-560. doi: 10.1038/eye.2015.3. Epub 2015 Feb 13.
Elhusseiny AM, Toma J, Rickels KL, et al. Risk of posterior capsular rupture in fellow eyes cataract surgery: a multicenter database study. Presented at the 2024 American Academy of Ophthalmology Annual Meeting, October 18-21, Chicago.Session: Cataract, PA005
