Posterior capsule opacification after cataract surgery in remote Australian Aboriginal patients

The aim of this retrospective study was to determine the rate of visually significant posterior capsular opacification formation after cataract surgery for Australian Aborigines living in rural or remote areas in the 'Top End' of the Northern Territory, Australia, and then to assess these patients' outcomes after capsulotomy.

Aboriginal patients living in remote areas of the Top End of the Northern Territory who underwent cataract surgery between 1994 and 1999 were identified from records at the three major hospitals in the region. The presence of posterior capsular opacification (PCO) was determined by clinical examination. The primary endpoint for this study was the presence of axial opacification of the posterior capsule and the need for subsequent Nd:YAG posterior capsulotomy to improve sight. Linear regression analysis of the time from surgery to follow up and the number of eyes requiring Nd:YAG capsulotomy was performed. Operated eyes were grouped according to the interval between surgery and follow up (Group 1: follow up within 1 year of surgery, n= 25; Group 2: follow up 1-3 years after surgery, n= 42; Group 3: follow up 3-5 years after surgery, n= 51).

One hundred and eighteen operated eyes were examined. Eyes in Group 3 were found to have the highest incidence of visually significant PCO (27.5%). There were more eyes requiring capsulotomy after 3 years than after 1 year following surgery. Linear regression analysis revealed an odds ratio of 1.4 (P = 0.07). All nine eyes in the 1-3 year group that had developed visually significant PCO had undergone extra-capsular cataract extraction.

For the remote Aboriginal patient who has undergone cataract surgery, there is a relatively minor chance of developing PCO within the first postoperative year regardless of the type of surgery undertaken. This study illustrates that the longer the time after surgery the greater the chance of developing visually significant PCO. For the remote Aboriginal patient there is a high chance (approximately 28%) of developing visually significant PCO within 5 years after cataract surgery. These figures are lower than those reported from other parts of Australia.