Posterior capsule rupture-causes, associations and outcomes: eight year analysis in a Malaysian General Hospital

AIM: To see the causative factors, associations and outcomes of posterior capsule rupture(PCR).<p>METHODS: A retrospective cohort study was done of all patients with PCR from 2007 to 2014 in Melaka Hospital. Associations between ocular comorbidities, lens related complications, surgeon grade, type of cataract surgery, whether done alone or in combination, with the occurrences of PCR were studied. The final visual outcome of cases with PCR was studied.<p>RESULTS: PCR was the commonest intraoperative complication(<i>n</i>=623, 4.8%)among 12 846 patients. Ocular comorbidities and status of the lens did not cause PCR. Experience and seniority of surgeons were significantly associated with PCR. Medical officers had more PCRs than gazetting specialists(<i>P</i>=0.0000), who inturn had more PCRs than specialists(<i>P</i>=0.000). Each type of cataract surgery done was also significantly associated with PCR-phacoemulsification(phaco), phaco convert to extracapsular cataract extraction(ECCE)and intracapsular cataract extraction(ICCE)(<i>P</i>=0.000), lens aspiration(<i>P</i>=0.020), and ECCE(<i>P</i>=0.003). Specialists got good outcomes compared to trainees without PCR occurring(<i>P</i>=0.001)and also with PCR occurring(<i>P</i>=0.013). However, no difference was observed in the occurrence of PCR in complicated cases between specialists and trainees. Vision was compromised mainly by astigmatism following PCR. Impaired vision(<i>P</i>=0.000)and poor vision(<i>P</i>=0.000)were more than good vision. Poor vision was more in PCR compared to other complications.(<i>P</i>=0.000).<p>CONCLUSION: PCR occurs in all types of cataract surgeries and is the main intraoperative complication causing poor vision. Good outcomes were significantly more when specialists got PCR compared to trainees. Junior surgeons should practice in wet labs and be given more cases