• Cataract/Anterior Segment

    Review of: Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery

    Segers M, Behndig A, van den Biggelaar F, et al. Journal of Cataract & Refractive Surgery, January 2022

    Posterior capsule rupture (PCR) is a significant complication of cataract surgery. This retrospective, cross-sectional, register-based study evaluated the incidence of and risk factors for development of PCR.

    Study design

    Investigators analyzed data from more than 2.8 million patients in the European Registry of Quality Outcomes for Cataract and Refractive Surgery who underwent cataract surgery between January 2008 and December 2018.


    The incidence rate of PCR was 1.1%; this is similar to what has been noted in other recent studies, though the incidence has been decreasing over time. Corneal opacities, comorbid eye diseases (e.g., diabetic retinopathy, macular degeneration), poor preoperative corrected distance visual acuity, and white cataract were the risk factors most significantly associated with PCR. Previous vitrectomy was not significantly associated with PCR.


    Limitations of this study include the fact that the risk factors analyzed were limited to those reported in the registry, which does not include previous intravitreal injections for example, and that the complication of PCR is self-reported and may be underreported by the surgeon.

    Clinical significance

    Preoperative recognition of the more frequently noted risk factors associated with PCR may help ensure that necessary equipment is available at the beginning of the case. The presence of these factors could also be used to help stratify risk and suggest cases that need to be scheduled with a more experienced surgeon, allowing trainees to operate on lower-risk patients. Adding these preemptive measures makes it more likely to achieve better outcomes following cataract surgery and reduce the incidence of PCR.