[Risk factors for secondary cataract]

Posterior capsule opacification represents a major public health concern, particularly in developing countries. It is the most common complication after cataract surgery. Its pathogenesis involves multifactorial mechanisms, including surgical, biomolecular, and patient-related factors.

A retrospective case-control study was initiated to identify the risk factors for the development of posterior capsule opacification.

Two hundred eyes undergoing cataract surgery at the ophthalmology department of Kasserine Regional Hospital between 2019 and 2023, operated by a single surgeon: one hundred cases of patients with secondary cataract compared with 100 controls (without posterior capsule opacification). We evaluated the risk factors related to the patient, the primary cataract, the surgical technique, intraoperative and postoperative complications. Statistical analysis was done in 3 steps: a univariate analysis, then a bivariate analysis using chi-square and the student tests and finally, we performed a multivariate analysis with a logistic regression.

The bivariate analysis identified 16 risk factors: age, female sex, glaucoma, uveitis, high myopia, exfoliation syndrome, white cataract, age related cataract, extracapsular extraction, type of the lens, biconvex lens, multipiece IOL lens, corneal opacities, ciliary sulcus implantation and persistence of residual cortical material. The multivariate analysis selected four principal factors: exfoliation syndrome, age related cataract, white cataract and ciliary sulcus implantation.

The main independent risk factors for posterior capsule opacification identified in this study were exfoliation syndrome, age-related cataract, white cataract, and ciliary sulcus implantation. Awareness of these factors enables targeted prevention, which may explain the current decline in secondary cataract incidence.