Abstract
Purpose :
The visual acuity (VA) outcomes, intra- and postoperative complications of cataract surgeries complicated by posterior capsule rupture (PCR) or dropped nucleus fragments (DNF) have not been reported. Here, we report the results of a retrospective, multicenter study comparing uncomplicated cataract surgeries to those complicated by PCR or DNF.
Methods :
After inclusion and exclusion criteria were met, we analyzed 178,859 eyes according to the VA at baseline and within three-month follow-up. Successful visual outcome was defined as VA≤0.3logMAR, and uncomplicated surgeries considered as reference group. Incidence of cystoid macular edema (CME), rhegmatogenous retinal detachment (RRD), and epiretinal membrane (ERM) were also analyzed. Statistical analysis between the pre- and postoperative VA and gains in Snellen lines was generated using ANOVA and chi-square tests with Bonferroni correction. Statistical significance was set at P<0.003. Multivariate logistic regression modeling to calculate the odds ratio between VA≤0.3logMAR and surgical complications at different time intervalswas also performed.
Results :
DNF and PCR group eyes developed inferior visual outcomes compared to reference group (0.67±0.65 vs.0.43±0.55 vs.0.20±0.33, respectively, p<0.003) with mean change in VA of -0.32±0.86 vs. 0.34±0.72 vs.-0.42±0.5, respectively, (p<0.003). DNF and PCR group eyes gained ≥0.3logMAR (~3Snellen lines) in 46.8% and 50.9% of eyes, respectively, compared to the 62% in the reference group (p<0.003). Among those eyes in DNF group, 204 eyes (41.23%) were managed surgically with pars plana vitrectomy (PPV) (44.79±28.5 days between procedure and PPV) and 315 eyes (58.77%) were conservatively managed. Mean change in VA among those eyes with DNF managed by PPV was higher than eyes managed conservatively (-0.17±0.90 vs.-0.48±0.79, p<0.003). The odds ratio of having CME, ERM, and RRD among eyes with DNF or PCR was significantly higher than reference group (1.603, 2.133, 3.646 in DNF group, vs. 2.18, 1.28, 1.76 in PCR group, respectively, p<0.003).
Conclusions :
We found that eyes are at risk of inferior VA when cataract surgery is complicated by DNF compared to eyes with PCR. In addition, eyes with PCR or DNF had worse VA and higher risk of CME, ERM, and RD compared to uncomplicated cases. Eye complicated with DNF that managed with PPV, had better VA compared to conservatively managed eyes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.