The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 17, A risk factor model for posterior capsule rupture

Abstract Background/ObjectivesTo create a risk factor model for posterior capsule rupture (PCR) during cataract surgery.Subjects/MethodsEligible cataract operations were performed between 01/04/2016 and 31/03/2022 in centres supplying data to the national cataract audit on at least 50 eligible operations with complete data for patients’ gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA). A logistic regression model was fitted to identify risk factors for PCR.ResultsThis analysis included 961 208 cataract operations performed on 682 381 patients from 136 participating centres by 3 198 surgeons. The final PCR risk factor model included surgical and patient factors comprising surgeon grade, patients’ gender and age, ability to lie flat and/or cooperate, diabetic status and an interaction between age and gender. Ocular factors were first or second eye surgery, ACD, preoperative VA, previous intravitreal therapy, pupil size, the presence or absence of amblyopia, brunescent / white / mature cataract, diabetic retinopathy, glaucoma, high myopia, previous vitrectomy and pseudoexfoliation / phacodonesis. The highest influencing risk factors were surgery by less experienced trainee surgeon, younger male patients and the presence of pseudoexfoliation / phacodonesis.ConclusionVarious surgical, patient and ocular factors increase the risk of PCR during cataract surgery. Appropriate case allocation should balance the risk to the patient with the requirement for trainee surgeons to gain experience. This risk factor model permits estimation of individualised risks for patients and allows risk-adjustment for surgeons to evaluate their PCR rates based on case complexity.