INTRAOPERATIVE CATARACT SURGERY COMPLICATIONS POST- PANDEMIC

To evaluate the intraoperative cataract surgery complications (posterior capsule rupture and zonule dialysis) in our department after the COVID-19 pandemic. Elective surgery such as cataract surgery was postponed during the initial pandemic lockdown and only emergency cataract surgery was performed. High flow cataract surgery was resumed in our unit from May 2021 onwards in a new purpose-built cataract centre. PCR is widely accepted as an indicator of surgical quality as it results in a higher risk of harm to the eye and can impair the final visual outcome. There is also a higher risk of retinal detachment in the year following cataract surgery if PCR occured.

Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom 

Retrospective analysis of cataract surgeries performed from 1st May 2021 to 31st May 2022 (post-pandemic) and from 1st May 2018 to 31st May 2019 (pre-pandemic) was performed. Eyes included were those that had undergone phacoemulsification +/- intraocular lens surgery and had PCR or zonule dialysis. Data collected included age, pre-op & post-op visual acuity, pre-existing ocular co-pathology, surgeon, management of the intraoeprative complication, IOL used or left aphakic, wound closure with suture or hydration, secondary surgery. PCR was defined as posterior capsule rupture with or without vitreous loss, zonular rupture with vitreous loss.

Total of 8168 phacoemulsification +/- IOL surgery were performed from 1st May 2021 to 31st May 2022. There were 96 PCR cases (1.18%) ad 11 zonule dialysis (0.18%). In comparison, total of 8533 phacoemulsification +/- IOL surgery were performed from 1st May 2018 to 31st May 2019 before the pandemic. The PCR rate was 1.39% (113 cases) and zonule dialysis rate was 0.26% (22 cases). Analysis of the PCR and zonule dialysis patients in the post-pandemic period showed that 44 eyes had ocular co-pathology and mean age was 74.7 years (range 33 to 95 years). In this group, 68 eyes (63.6%) were operated by consultants, 20 (1.9%) operated by more experienced trainees/trust grade/fellows, 16 (1.5%) cases operated by less experienced surgeons. 2 eyes had AC IOL, 33 eyes with IOL in the bag, 48 eyes with sulcus IOL, 24 eyes left aphakic in the primary catarct surgery.  30 eyes (28%) had secondary surgery (vitrectomy +/- secondary IOL). 2 cases had two or more surgeries to manage the complication. Majority of the cases 83.2% (84 out of 101 cases)  achieved post-op visual acuity of at least 6/12 or better. 6 eyes (5.9%) had visual loss post-op. 

Good post-operative visual outcome can still be achieved in PCR cases if it is managed appropriately intraoperatively in the primary cataract surgery and most of the cases (72%) did not require secondary surgery. There was no siginificant difference in the PCR rate before and after the COVID-19 pandemic in our unit.