The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture
Peng Yong Sim, Paul H. J. Donachie, Alexander C. Day, John C. Buchan
{"title":"The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture","authors":"Peng Yong Sim, Paul H. J. Donachie, Alexander C. Day, John C. Buchan","doi":"10.1038/s41433-024-03344-2","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background/Objectives</h3><p>To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery.</p><h3 data-test=\"abstract-sub-heading\">Subjects/Methods</h3><p>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.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>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, <i>p</i> < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05–3.94, <i>p</i> < 0.001), younger males (OR 3.05, 95% CI 2.23–4.16, <i>p</i> < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24–2.60, <i>p</i> < 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.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>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.</p>","PeriodicalId":12125,"journal":{"name":"Eye","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Eye","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41433-024-03344-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
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.
期刊介绍:
Eye seeks to provide the international practising ophthalmologist with high quality articles, of academic rigour, on the latest global clinical and laboratory based research. Its core aim is to advance the science and practice of ophthalmology with the latest clinical- and scientific-based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthoptists, other health care professionals and research workers in all aspects of the field of visual science worldwide. Eye is the official journal of The Royal College of Ophthalmologists.
Eye encourages the submission of original articles covering all aspects of ophthalmology including: external eye disease; oculo-plastic surgery; orbital and lacrimal disease; ocular surface and corneal disorders; paediatric ophthalmology and strabismus; glaucoma; medical and surgical retina; neuro-ophthalmology; cataract and refractive surgery; ocular oncology; ophthalmic pathology; ophthalmic genetics.