Posterior capsule rupture during cataract surgery: analysis of visual outcomes and associated risk factors

To evaluate visual outcomes and identify risk factors for poor visual prognosis and dropped nucleus following posterior capsule rupture (PCR) during cataract surgery over a 5-year period in an Asian tertiary institution.

A retrospective chart review.

All eyes that were complicated by PCR during cataract surgery at Tan Tock Seng Hospital, Singapore, between January 2016 and December 2020.

Medical records were reviewed for demographics, preoperative, intraoperative, and postoperative data. The primary outcome measures were best-corrected visual acuity (BCVA) ≥20/40 at 3 months (short-term visual outcome) and at final follow-up (long-term visual outcome). Logistic regression identified independent predictors of poor visual outcomes and intraoperative dropped nucleus.

Among 31,663 phacoemulsification cataract surgeries performed during the study period, 234 (0.74%) were complicated by PCR. Of 211 eyes with PCR analyzed for vision, 191 (90.5%) achieved BCVA ≥20/40 at 3 months, and 174 (83.3%) maintained this at final follow-up (median 35 months). Predictors of poor final vision included increasing age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.00-1.10; p = .042), postoperative complications (OR: 8.17; 95% CI: 3.34-20.56; p < .001), and non-in-the-bag lens status (OR: 3.89; 95% CI: 1.56-9.69; p = 0.003). Dropped nucleus was associated with early PCR (OR: 8.37; 95% CI: 2.39-32.61; p = 0.001) and vitreous loss (OR: 20.66; 95% CI: 3.95-386.89; p = 0.004).

Despite PCR, most patients achieved favourable long-term visual outcomes. Poor long-term visual prognosis was associated with older age, postoperative complications, and non-in-the-bag lens status. Early PCR and vitreous loss were key predictors of dropped nucleus.