Official ESCRS | European Society of Cataract & Refractive Surgeons


Cataract surgery volumes from 2007 to 2016: relation to case mix and composite risk score for capsule complication – data from the Swedish National Cataract Register

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Session Details

Session Title: Combined Cataract Surgery & Practice Styles

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 14:52

Venue: Free Paper Forum: Podium 2

First Author: : M.Zetterberg SWEDEN

Co Author(s): :    A. Behndig                             

Abstract Details


To investigate case mix in relation to capsule complication, possible associations between case mix and operation volume and change in case mix over time.


All cataract procedures reported to the Swedish National Cataract Register (NCR).


Demographics and data on preoperative best-corrected visual acuity (BCVA), ocular comorbidity, intraoperative difficulties and capsule complications were collected prospectively during 2007 to 2016 and analysed in relation to coded data on individual surgeons’ operation volume classified as either high-volume (≥500 procedures yearly), medium-volume (100-499 procedures/year) or low-volume (10-99 procedures/year). Single factor analysis and logistic regression was performed and a composite risk score was created.


Capsule complications were associated with preoperative BCVA <0.1 (aOR 1.82 p<0.001), pseudoexfoliations (aOR 1.53 p<0.001), sight-threatening ocular comorbidity (aOR 1.35 p=0.006), use of trypan blue (aOR 1.76 p<0.001), mechanical pupil dilation (aOR 1.36 p=0.024) and iris hooks at rhexis margin (aOR 6.99 p<0.001). High-volume cataract surgeons had significantly lower mean composite risk score; ≤1.28 (range 1.01-2.02) compared to low- and medium-volume cataract surgeons; 1.34±0.56 (1.00-4.55) and 1.49±0.58 (1.01-5.19). During 2007-2016, the proportion of patients >88 years of age, BCVA <0.1 and intraoperative difficulties decreased whereas the number of patients with ocular comorbidity increased.


Case mix, as calculated from a composite risk score based on pre- and intraoperative parameters registered in the NCR, may explain the decrease in capsule complications from 2007 to 2016 and also the lower complication rate for high-volume surgeons.

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