Operative Factors That Influence Visual Outcome In Complicated Cataract Surgery

The purpose of this study was to describe the current management practice of complications during cataract surgery at our institution and to ascertain whether intraoperative and postoperative management affects eventual visual outcomes, in order to identify optimal management.

Tertiary teaching hospital in the South West of England

Cases of primary phacoemulsification surgery complicated by posterior capsular rupture (PCR) or zonular rupture (ZR) between January 2019 and January 2023 were captured and data collection completed using Medisoft EPR. Post-operative poor visual acuity (VA) was deemed to be 1.0 LogMAR or worse. Intraoperative factors, such as grade of surgeon, dropped fragments, insertion of IOL and vitreous loss, as well as postoperative factors, such as requirement of secondary anterior vitrectomy, pars plana vitrectomy or secondary IOL implantation, were considered as potentially influencing final visual acuity.

There were 203 cases of complicated cataract surgery during the study period: 167 PCRs and 46 ZRs. Final postoperative VA was the same or better in 79.5% (n=147). Whilst poor visual outcome of LogMAR 1.0 or worse occurred in 13.5% (n=25) of cases, 59.3% (n=110) had VA of LogMAR 0.3 or better at final follow-up. 37.9% (n= 77) required further surgical intervention: 23.6% (n=48) implantation of a secondary IOL and 12.8% (n=26) pars plana vitrectomy for retained lens fragments. Surgery performed by registrars had a higher rate of poor visual outcome as compared to fellows or consultants (21% vs 12% vs 10%), though this did not reach statistical significance. Intraoperative vitreous loss was significantly associated with poor visual outcome.

Vitreous loss during primary cataract extraction and lens implantation was associated with poor visual outcomes, as was being left aphakic in the primary procedure. Requiring subsequent vitrectomy to remove retained lens fragments in the posterior chamber was not associated with poor outcomes. Complicated cataract surgery performed by registrars was more likely to result in poorer visual acuity outcomes, as well as require further operative management.