Skip to main content

  • Cataract Surgery Volume and Risk of Capsular Complications

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, March 2021

    Download PDF

    Although cataract extraction is a relatively safe and routine procedure, sight-threatening complications can occur. Using data from Swed­ish patients who underwent cataract surgery in a 10-year period, Zetterberg et al. looked at case mix in relation to capsular complications, possible associations be­tween case mix and surgeon volume, and changes in case mix over time. They found that capsular complications were significantly associated with best-corrected visual acuity (BCVA) ≤0.1 logMAR units at baseline as well as with the presence of pseudoexfoliation (PEX), the use of Trypan blue, and placement of iris hooks at the rhexis margin.

    The authors calculated a composite risk score from the data of 118,493 patients in the 2016 cohort (mean age, 74.2 years). Parameters included age, sex, BCVA, ocular comorbidity (excluding glaucoma, age-related macular degeneration, diabetic retinopathy, and cornea guttata), intraoperative difficul­ties, and whether communication with the vitreous occurred during surgery. Some data were not available for every year, and the analyses were modified accordingly. Single regression analyses of possible pre- and intraoperative risk factors were conducted, and any factor that significantly raised the risk for capsular complications in that analysis was evaluated subsequently by logistic binary regression. Case mix and surgeon volume were stratified by category. The main outcome measure was risk of capsular complication (adjusted and com­posite odds ratios) in relation to sur­gery volume.

    Results showed that various pre- and intraoperative factors were linked to capsular complications in the single-factor and logistic re­gression analyses; these included pre-op BCVA ≤0.1, PEX, other ocular comorbidity, Trypan blue use, mechanical pupil dilation, and iris hooks at the rhexis margin. The composite risk score was significantly lower for high-volume surgeons (≥500 procedures per year) than for those with low or me­dium case volumes (mean risk scored: 1.28, 1.34, and 1.49, respectively).

    Case mix may contribute to the overall decline in capsular complica­tions from 2007 to 2016, the authors said. Moreover, as time passed, there were decreases in the percentage of oldest patients (>88 years), those with poor baseline BCVA, and cases with intraoperative difficulties. Further work is planned to explore the effect of clinical setting on complication rates and case mix.

    The original article can be found here.