The Australian Training Experience: Posterior Capsule Tear Rates And Visual Outcomes In Consultant Vs. Registrar Cataract Surgery

To describe the posterior capsule (PC) tear rates and visual outcomes after phacoemulsification, analyze risk factors contributing to PC tears, and compare results of consultants and registrars.

 Department of Ophthalmology, The Alfred Hospital, Melbourne, Australia. An Australian university-attached quaternary referral centre. 

Retrospective study of consecutive patients who underwent phacoemulsification over a 10-year period at The Alfred, Melbourne, Australia. All cases with PC tears were identified and included in the study. Patients with insufficient follow-up data were excluded. Demographic data, risk factors, complications, and visual outcomes were recorded. PC tear rates of consultants and registrars were also compared.

There were 130 PC tears in 12, 746 phacoemulsification cases (rate 1.02%). The incidence rates for consultants and registrars were 1.3% and 0.9%, respectively. Key risk factors for PC tear were age >65 years old and presence of dense cataract. Ruptures most frequently occurred in phacoemulsification (26.7%) and irrigation and aspiration (26.7%) stages of surgery. The incidence of vitreous loss necessitating anterior vitrectomy was 0.71%. BCVA of 6/12 or better post-operatively was achieved by 68.8% of patients.

The rate of PC tears (1.02%) was equal to or lower than the majority of other published studies (1.0% - 3.5%). Registrars had a slightly lower rate of PC tears compared to that of consultants. This may be a result of consultants being allocated more complex cases. The BCVA of 6/12 or better (68.8%) was worse than that of other published studies (89% - 98%). PC tears remain an important complication of phacoemulsification and may confer sub-optimal visual outcomes. Key risk factors, such as, age >65 years old and presence of dense cataract should be considered in preoperative planning.