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S. Baharestani, M. Cho, L. T. D. Sperber, J. M. Dodick; Risk Factors for Posterior Capsule Rupture Necessitating Anterior Vitrectomy in Patients Undergoing Cataract Extraction by Phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5574.
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To investigate risk factors that may help to predict posterior capsule rupture (PCR) necessitating intraoperative anterior vitrectomy (AV) in patients undergoing cataract extraction by phacoemulsification
A retrospective review of 19 cases of cataract extraction by phacoemulsification complicated by PCR and AV and 20 randomly selected cases of uncomplicated cataract surgery performed at the Manhattan Eye, Ear, and Throat Hospital from August 2007 to October 2008. All cases were performed by attending cataract surgeons experienced in phacoemulsification surgery. Medical records were screened for age, race, medical co-morbidities, ocular co-morbidities, and ocular parameters.
Mean age for the surgical complications group was 74.2 (47% female) and 77.0 years (50% female) for controls. Overall, patients requiring AV for PCR had poorer pre-operative best corrected visual acuities, as 72.2% versus 55.6% were 20/70 or worse in the operative eye. Diabetic retinopathy (15.8% vs. 0%) and primary open-angle glaucoma (26.3% vs. 10.0%) were also more common in the group with PCR, but pseudo-exfoliation syndrome showed no clear distinction (5.3% vs. 5.0%). Presence of concomitant hypertension (63.2% vs. 55.0%), coronary artery disease (42.1% vs. 35.0%), hypercholesterolemia (36.8% vs. 25.0%), and/or chronic obstructive pulmonary disease (11.8% vs. 5.0%) were associated with an increased incidence of PCR in the complications group. Treatment with tamulosin for benign prostatic hyperplasia was more often seen in the PCR group - 31.6% vs. 10.0%. In addition, previous ocular surgery in the eye undergoing cataract extraction correlated with PCR in 21.1% of cases, as compared to 10.0% of controls.
The identification of medical and ocular co-morbidities may play a useful role in pre-operative risk stratification of potential PCR requiring AV during phacoemulsification cataract extraction. Further study of these and other risk factors is necessary to assign definitive relationships that may help to predict and/or prevent surgical complications.
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