What question did this study set out to answer?

The study aims to determine the incidence of posterior capsule rupture and vitreous loss during cataract surgery and assess preoperative risk factors.

April 4, 2026Open Access

Posterior Capsule Rupture and Vitreous Loss in Cataract Surgery: A Retrospective Analysis from a Swiss Tertiary Center

Key Points

The study aims to determine the incidence of posterior capsule rupture and vitreous loss during cataract surgery and assess preoperative risk factors.
Retrospective cohort study at a Swiss tertiary care center
Included phacoemulsification and refractive lens exchange between January 2021 and August 2024
Data retrieved from clinical database and manual chart review
Logistic regression analyses to evaluate associations between preoperative factors and complications
PCR and/or VL occurred in 52 eyes (1.9%)
45 cases of PCR reported, with 5 having concomitant VL
Univariate analysis showed pseudoexfoliation and TCS ≥ 3 linked to increased risk
Topical anesthesia associated with reduced risk
Only PEX remained a significant independent risk factor in multivariate analysis

Abstract

Purpose: To determine the incidence of posterior capsule rupture (PCR) and vitreous loss (VL) during cataract surgery in a Swiss tertiary care center. Furthermore, we aimed to evaluate preoperative risk factors associated with PCR/VL, including pseudoexfoliation (PEX), age, type of anesthesia, and the Triemli Cataract Score (TCS), a locally implemented preoperative risk assessment tool for surgical complexity. Methods: This retrospective single-center cohort study included all phacoemulsification and refractive lens exchange procedures performed at Stadtspital Zürich between January 2021 and late August 2024. Data were retrieved from the Dendrite clinical database of the TCS and supplemented through manual chart review and surgical reports for identification of intraoperative complications. Univariable and multivariable logistic regression analyses were performed to evaluate associations between preoperative factors and the occurrence of PCR and/or VL. Results: A total of 2’ 719 eyes were included in the study. PCR and/or VL occurred in 52 eyes (1.9%), including 45 cases of PCR (5 with concomitant VL) and 7 additional cases of isolated VL due to zonulolysis. In univariate analysis, PEX and a TCS ≥ 3 were significantly associated with an increased risk of PCR and/or VL (OR 2.72; p=0.003 and OR 2.38; p=0.002, respectively), while topical (vs. general) anesthesia was associated with a reduced risk (OR 0.51, p=0.019). In multivariate analysis, only PEX remained an independent risk factor (OR 2.38; p=0.013). The association between TCS ≥ 3 and PCR/VL just missed statistical significance (OR 1.79; p=0.057). Conclusion: The rate of PCR and/or VL during cataract surgery at a Swiss tertiary care center is comparable to international statistics. PEX is a strong and independent predictor for these complications; although the predictive power of TCS did not reach statistical significance in multivariable analysis, the observed trend suggests that risk-based preoperative scores such as the TCS may support risk-stratification and surgical planning in clinical practice. Keywords: surgical complications, triemli cataract score, phacoemulsification, risk factors

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