ESCRS - FP09.02 - The Royal College Of Ophthalmologists’ National Ophthalmology Database: Association Of Surgeon Volume With Posterior Capsular Rupture Risk

The Royal College Of Ophthalmologists’ National Ophthalmology Database: Association Of Surgeon Volume With Posterior Capsular Rupture Risk

Published 2026 - 44th Congress of the ESCRS

Reference: FP09.02 | Type: Free paper | DOI: 10.82333/n70m-h561

Authors: A/Prof. Alexander Day** 1 , Mr Peng Yong Sim 1 , Mr Paul Donachie 2 , Mr Michael Burdon 3 , Mr John Buchan 4

1Moorfields Eye Hospital,London,United Kingdom, 2Royal College of Ophthalmologists,London,United Kingdom;Gloucestershire Hospitals NHS Foundation Trust,Cheltenham,United Kingdom, 3Royal College of Ophthalmologists,London,United Kingdom;County Durham and Darlington NHS Foundation Trust,Darlington,United Kingdom, 4Royal College of Ophthalmologists,London,United Kingdom;International Center for Eye Health,London School of Hygiene and Tropical Medicine,London,United Kingdom;Leeds Teaching Hospitals NHS Trust,Leeds,United Kingdom

Purpose

To investigate the association between posterior capsular rupture (PCR) risk and annual surgical volumes for fully trained surgeons in the UK.

Setting

Retrospective observational study of phacoemulsification surgeries performed between 01/04/2021 and 31/03/2024 by fully trained surgeons registered on the UK General Medical Council’s specialist register from centers supplying data to the UK national cataract audit (RCOphth NOD).

Methods

Observed (unadjusted) PCR rates were calculated from the supplied data and expected (predicted probability based on case complexity) PCR rates
were calculated using a published risk factor model. Fractional polynomials were used to estimate the underlying distribution of observed and expected PCR rates for surgeon annual volume. Main outcome measures were unadjusted and expected PCR rates for different surgeon annual volume groups.

Results

993,001 operations performed by 1314 surgeons from 206 centers were eligible for analysis. PCR occurred in 5819 (0.59%) eyes and the observed PCR rate steadily decreased as surgeons’ annual volume increased. The unadjusted PCR rate was consistently higher than the expected PCR rate for surgeons performing <250–300 surgeries per year, although there was high variability in the PCR rates for lower volume groups. There was lower cataract surgery case complexity for higher annual volume surgeons and the expected PCR rate decreased to lower than the whole sample unadjusted PCR rate of 0.59% at around 600 operations per year.

 

Conclusions

A clear association was found between surgeons performing a higher annual volume of cataract surgery and lower PCR rates. This finding should inform resource planning for cataract services to provide sufficient surgeon volume for improved patient outcomes, with a recommended case volume of at least 250 cases per year.