Risk stratifying for posterior capsule rupture: validity and utility for senior surgeons performing high-volume cataract surgery

Session Details

Session Title: Combined Cataract Surgery & Practice Styles

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 14:58

Venue: Free Paper Forum: Podium 2

First Author: : A.Silvester UK

Co Author(s): :    A. Pitalia                             

Abstract Details

Purpose:

National UK guidelines for cataract surgery recommend the use of a risk stratification algorithm pre-operatively to identify people at increased risk of complications and to minimise risk by supervising trainee surgeons during these cases. The aim of this study was to validate risk stratification for posterior capsule rupture and determine its' utility when the surgery is performed by senior surgeons.

Setting:

Multi-centre retrospective analysis of cataract surgery performed in England by 19 consultant surgeons between January 2012 and January 2018.

Methods:

An analysis of Medisoft cataract database (Leeds UK) of all patients undergoing cataract surgery at 6 hospitals in England. Posterior capsule rupture (PCR) risk factors analysed included age, sex, brunescent cataract, pseudo-exfoliation, small pupil, glaucoma, long axial length and PCR risk score >8% (using a previously validated risk score). Visual outcomes, number of follow up appointments and further procedures were analysed for all patients with complicated surgery resulting in a dropped nucleus. Comparisons were made with a cohort of patients, risk stratified at pre-assessment and performed on complex cataract lists by vitero-retinal (VR) surgeons.

Results:

22,303 cataract operations performed, PCR rate 0.56%. Risk of PCR was significant in brunescent cataract (OR 2.88 P<0.0001), pseudo-exfoliation (OR 3.26 P = 0.005), age >80 years (OR 1.6 P = 0.0001) and PCR risk score >8% (OR 2.52, P<0.0001). Small pupil, glaucoma and long axial length were not significant risk factors in this cohort. 10 operations had dropped nucleus (0.04%), all patients had pars plana vitrectomy within 7 days of primary surgery (2 patients required an additional procedure), 80% patients obtained 6/12 visual acuity or better (100% excluding pre-existing pathology), mean number of follow ups was 5 (2-10).

Conclusions:

This study has validated existing risk scores for senior surgeons; PCR risk score >8%, brunescent cataract, pseudo-exfoliation and aged over 80 years, were statistically significant risk factors for PCR. Risk stratification at pre-assessment supports the consent process by providing patients with an accurate risk profile. In high risk cases, VR surgeons performing the cataract surgery may not reduce the risk of a PCR, however, may reduce the number of additional operations and follow ups required when they do occur, a potential utility for both patient and surgeon.

Financial Disclosure:

None