New cataract surgery risk classification system may improve patient safety

The authors of this correspondence present a method for classifying the difficulty of cataract surgery cases and predicting posterior capsule rupture risk. It combines elements of three existing scoring systems with known risk factors for cataract surgery. They believe this method can improve patient safety, provide a safe environment for all stages of surgeon training and improve audit quality regarding surgical selection and outcomes.

The cataract surgery classification (CC) system assigns cases one of three grades. CC1 are the easiest surgeries, with no comorbidities, moderate nuclear sclerotic cataract and good dilation, and are ideal for inexperienced trainees. CC2 involve comorbidities, such as diabetes or glaucoma, or other more complex issues like soft cataracts or very long or short axial length, and require an experienced trainee or consultant. CC3, the most difficult cases, incorporate such issues as shallow anterior chamber or a subluxated lens or more complex comorbidities like Fuch's endothelial dystrophy or pseudoexfoliation, and require the presence of a consultant.

The authors say they have used this system to plan surgical lists for more than 10 years in their ophthalmic training unit at Princess Alexandra Eye Pavilion in Edinburgh, Scotland. I also have used such a system for many years and find it very useful.