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The Royal College of Ophthalmologists’ National ophthalmology database study of cataract surgery: Report 14, cohort analysis – the impact of CapsuleGuard® utilisation on cataract surgery posterior capsule rupture rates

Eye (2024)Cite this article

Subjects

Abstract

Background/Objectives

The aim of this study was to investigate whether the use of the silicone tipped irrigation/aspiration (I/A) handpiece CapsuleGuard® (Bausch + Lomb, Laval, Canada) reduced rates of posterior capsule rupture (PCR) during cataract surgery.

Methods

Royal College of Ophthalmologists’ National Ophthalmology Database (NOD) Cataract Audit data from 01/04/2010 and 31/03/2021 and Bausch + Lomb sales figures were combined to identify centres participating in national cataract audit who have routinely adopted the silicone tipped I/A handpiece, CapsuleGuard®. Data were included only from centres with eligible cataract operations recorded on the NOD both before and after adopting CapsuleGuard®. Review of the literature was undertaken to estimate the proportion of PCR that occurs during I/A, to evaluate the impact of adoption of CapsuleGuard® on PCR occurring in this phase of surgery.

Results

Within the study period, 267 371 eligible cataract operations were performed in 14 centres with >50 eligible operations both before and after adopting CapsuleGuard®. Within centres adopting CapsuleGuard®, the rate of PCR occurrence reduction was 16.4%. Before and after the adoption of CapsuleGuard® the median change of PCR was 21.7% reduction (IQR: 4.8% to 37.7% reduction).

Conclusions

A reduction in the rate of PCR was seen after regular adoption of CapsuleGuard® during cataract operations. Review of published studies attributing PCR to various components of the cataract operation suggest around 25% of PCR may occur during I/A; adoption of CapsuleGuard may, therefore, be associated with avoidance of a substantial proportion of the PCR during that phase of surgery.

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Fig. 1: The PCR rate of centres before and after adoption of CapsuleGuard® by NHS year.

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Data availability

The RCOphth NOD Cataract Audit data supporting the results reported in this article are available by application to the RCOphth; associated costs for data preparation and provision would be covered by those applying to access the data. Data used to identify centres utilising CapsuleGuard™ is commercially sensitive and not publicly available.

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Acknowledgements

It is with gratitude that we remember our friend and colleague Robert Johnston, who sadly died in September 2016. Without his inspirational vision, determination and career long commitment to quality improvement in ophthalmology this work would not have been possible. We acknowledge the support of the hospitals that participated in this National Ophthalmology Database Audit study and thank our medical and non-medical colleagues for the considerable time and effort devoted to data collection. The participating centres included in this study are listed in alphabetic order below: Barking, Havering and Redbridge University Hospitals NHS Trust; Bradford Teaching Hospitals NHS Foundation Trust; East Kent Hospitals University NHS Foundation Trust; Epsom and St Helier University Hospitals NHS Trust; Hampshire Hospitals NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Liverpool University Hospitals NHS Foundation Trust; Manchester University NHS Foundation Trust; Mid Cheshire Hospitals NHS Foundation Trust; Mid Yorkshire Teaching NHS Trust; Royal Devon University Healthcare NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; Wirral University Teaching Hospital NHS Foundation Trust.

Funding

The analysis in this study was funded by Bausch + Lomb, however the data collection from centres, analysis and write up was independent of Bausch + Lomb. No editorial rights were assigned to Bausch + Lomb and the commitment to publish the findings regardless of the direction of results was established by the authors prior to commencement. The RCOphth National Ophthalmology Database Cataract Audit is currently funded through participation fees from centres as well as unrestricted financial contributions from Alcon and Bausch + Lomb.

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Authors and Affiliations

  1. The Leeds Teaching Hospital NHS Trust, Beckett Street, Leeds, LS9 7TF, UK

    John C. Buchan

  2. The Royal College of Ophthalmologists’ National Ophthalmology Database Audit, 18 Stephenson Way, London, NW1 2HD, UK

    John C. Buchan, Charlotte F. E. Norridge, Beth Barnes, Martina Olaitan & Paul H. J. Donachie

  3. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

    John C. Buchan

  4. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK

    Charlotte F. E. Norridge & Paul H. J. Donachie

Authors
  1. John C. Buchan
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  2. Charlotte F. E. Norridge
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  3. Beth Barnes
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  4. Martina Olaitan
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  5. Paul H. J. Donachie
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Contributions

All authors discussed the original idea regarding how to evaluate the introduction of new technology to UK cataract service provision using NOD data; JB, CN and PD developed the details of the data collection and analysis plan. CN and PD undertook statistical analysis and JB led the writing of the paper with all authors discussing conclusions and reviewing the final manuscript.

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Correspondence to John C. Buchan.

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Buchan, J.C., Norridge, C.F.E., Barnes, B. et al. The Royal College of Ophthalmologists’ National ophthalmology database study of cataract surgery: Report 14, cohort analysis – the impact of CapsuleGuard® utilisation on cataract surgery posterior capsule rupture rates. Eye (2024). https://doi.org/10.1038/s41433-024-03003-6

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