DEC 02, 2009
Cataract/Anterior Segment, Comprehensive Ophthalmology
The Swedish Capsule Rupture Study analyzed data on cataract extractions collected in a national database to further describe capsule complication during cataract surgery.
Over the course of one year, 324 cases of capsule complication occurred. Controls, 331 procedures, were selected as the first uneventful procedure in the database after each procedure with a complication. Using these records, 369 patients were recruited for a follow-up examination three years after the original cataract extraction. Here's what they found:
- The average cost of a procedure with a capsule complication was approximately double the cost of an uneventful cataract extraction. Report 1
- Preoperative conditions associated with a capsule complication were: previous trauma, white and brunescent/hard cataract and phacodonesis. Intraoperative factors significantly overrepresented in the complication group: loose zonules, use of trypan blue and miosis, as were eyes operated on by surgeons with the least experience. Report 2
- Patients with a capsule complication had a significantly worse visual outcome and a doubled risk for no improvement in preoperative visual acuity. Pupil distortion, iris damage, synechias and subjective complaints related to the eye were significantly more common in patients with a capsule complication. Report 3
- Patients who experience capsule complications had a 10 times greater risk of retinal detachment. Report 4
This series reports several important findings. Among them the fact that there was a 10 times greater risk of retinal detachment (RD) after capsule complications. The biggest message is that many were macula-off RDs, indicating that early symptoms were ignored or not understood by patients.
Also the poor visual outcomes of patients who had capsule complications is surprising and is perhaps suggestive of a need for courses on early recognition and ways to limit collateral damage once a complication occurs.
The authors make another salient point regarding the experience of surgeons, as well as long waits for second surgery in a socialized system. They suggest that perhaps high risk eyes should be referred to more experienced surgeons. Also patients may really suffer by having to wait too long in a socialized system especially for second eye surgery exposing them to more risk than necessary.
"By preoperatively identifying cataract cases with the identified risk factors and allocating them to surgeons with the longest experience, the number of capsule complications could be kept low. Operating early in the course of the disease to prevent the cataract from becoming a poor surgical risk and improving training of junior surgeons should further reduce the frequency of capsule complications."