An analysis of posterior capsule rupture (PCR) rate and risk stratification within the National Health Services (NHS)

Abstract

Purpose: Posterior capsule rupture (PCR) is a serious complication of cataract surgery, which can lead to other complications such as cystoid macular oedema, retinal detachment and endophthalmitis1,2. The aim of our study was to firstly, ascertain the rate of PCR in patients undergoing phacoemulsification and intraocular lens implant (IOL) surgery at Rochdale Eye Unit, UK. Secondly, to identify the factors contributing to increased risk of PCR. Thirdly, to establish whether patients are being appropriately screened for risk factors for PCR. Methods: A retrospective study of patients that underwent phacoemulsification and IOL surgery between 1st September 2021 and 1st April 2022 was performed. A total of 1179 patients were obtained using electronic records (OpenEyes™https://openeyes.apperta.org/). Results: Of the 1179 patients, 18 patients (1.52%) experienced PCR with or without vitreous loss. Pre‐procedure PCR risk was not calculated for any of them. 11 (61%) cases were carried out by consultants, 6 (33%) by registrars, and 1 (6%) by an associate specialist. Increasing age (above 70 years), excess movement, and co‐morbidities were associated with an increased risk of PCR. Only 7 (0.6%) of the 1179 patients had the PCR risk estimated (using OpenEyes™ calculator) prior to booking of procedure. The calculator considers presence of glaucoma, diabetes, the density of the cataract, and experience of the surgeon, among other factors. The risk was not calculated in 1109 (94%) patients. Conclusions: The risk of PCR during phacoemulsification and IOL surgery rises with increasing patient age, presence of co‐morbidities, and procedure undertaken by junior surgeons. Through greater utilization of PCR risk calculation, encouraged with electronic prompts and educational posters, this risk can be further reduced. The method may also be adapted by other National Health Service (NHS) Trusts in their cataract listing proforma. References 1. Thevi T, Sahoo S, Kyaw Soe HH. Posterior Capsule Rupture during Phacoemulsification among Patients with Pseudoexfoliation – Is There A correlation? The Malaysian Journal of Medical Sciences. 2014;21(4):51–53. 2. Chakrabarti A, Nazm N. Posterior Capsular Rent: Prevention and Management. Indian Journal of Ophthalmology. 2017;65(12):1359–1369.