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

Eye (2024)Cite this article

Subjects

Abstract

Background/Objectives

To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery.

Subjects/Methods

Eligible operations between 01/04/2016 and 31/03/2022 from centres supplying data to the UK national cataract audit with complete data including patients’ gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA) were included. A logistic regression model was fitted to identify risk factors and calculate their odds ratios (OR) and 95% confidence intervals (CI) for PCR.

Results

This analysis included 961,208 cataract operations performed on 682,381 patients from 136 participating centres by 3198 surgeons. 9730 (1.01%) of surgeries were complicated by PCR. The median age was 75.7 and 76.7 years for first and second eye surgery respectively, and 5154 (53.0%) were female. The highest risk factors for PCR were less experienced trainee surgeon (OR 3.75, 95% CI 3.33–4.24, p < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05–3.94, p < 0.001), younger males (OR 3.05, 95% CI 2.23–4.16, p < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24–2.60, p < 0.001). Other risk factors identified were glaucoma, worse preoperative VA, previous intravitreal therapy, high myopia, previous vitrectomy, systemic diabetes, diabetic retinopathy, amblyopia, older age, shallower ACD and inability to lie flat and cooperate.

Conclusion

Various surgical, patient and ocular factors increase the risk of PCR during cataract surgery. 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.

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Fig. 1: Observed PCR rates for patients’ age and gender displayed in 5-year age bandings.
Fig. 2: Observed PCR rates for preoperative LogMAR visual acuity displayed in 0.10 LogMAR bandings.
Fig. 3: Observed PCR rates for anterior chamber depth displayed in 0.1 mm increments.

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Data availability

Access to the data from the RCOphth NOD cataract audit can be accessed by application from appropriate academic or clinical organisations to noa.project@rcophth.ac.uk, however, preparation of the data would require a fee to cover full costs of extracting and preparing the necessary data for the intended purpose from the National Ophthalmology Database.

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Acknowledgements

We acknowledge with thanks the contribution of Professor John Sparrow who provided diligent clinical and academic oversight and leadership of the RCOphth NOD over many years to bring it to its current stature. 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 conscientious electronic data collection as they go about caring for their patients. The full list of the 136 participating centres included in this study is detailed in Supplementary File 4.

Funding

The RCOphth NOD Cataract Audit is currently funded through participation fees from centres as well as unrestricted financial contributions from Alcon and Bausch and Lomb. This research was supported by the NIHR Moorfields Clinical Research Facility and NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology.

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Authors and Affiliations

  1. Moorfields Eye Hospital NHS Foundation Trust, London, UK

    Peng Yong Sim & Alexander C. Day

  2. The Royal College of Ophthalmologists’ National Ophthalmology Database, London, UK

    Paul H. J. Donachie & John C. Buchan

  3. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK

    Paul H. J. Donachie

  4. UCL Institute of Ophthalmology, London, UK

    Alexander C. Day

  5. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    John C. Buchan

  6. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK

    John C. Buchan

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Contributions

PYS, PHJD, ACD and JCB conceptualised the study. PHJD prepared the study data and performed the statistical analysis. All authors contributed to interpretation of the results. PYS and PHJD wrote the first draft of the manuscript. All authors contributed to critical revision of the manuscript and approved the final manuscript. JCB is the overall content guarantor.

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Correspondence to Peng Yong Sim.

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ACD is a serving member of the Eye editorial. The rest of the authors declare no conflict of interest.

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Sim, P.Y., Donachie, P.H.J., Day, A.C. et al. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture. Eye (2024). https://doi.org/10.1038/s41433-024-03344-2

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