Reply: Risk factors for posterior capsule rupture in cataract surgery as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

Abstract

We want to thank the editor for the opportunity to respond to Galvis et al. Our study identified several major risk factors for posterior capsule rupture (PCR), such as corneal opacities (adjusted odds ratio [aOR] 3.21, 95% CI 3.02-3.41, P < .001), diabetic retinopathy (aOR 2.74, 95% CI 2.59-2.90, P < .001), poor preoperative corrected distance visual acuity (aOR 1.98, 95% CI 1.88-2.07, P < .001), and white cataract (aOR 1.87, 95% CI 1.72-2.03, P < .001). We also found that hyperopic target refraction (+0.51 diopters [D] to +1.50 and +1.51 to +6.00 D) is a risk factor for PCR (aOR 1.24, 95% CI 1.08-1.43, P = .002, and aOR 1.37, 95% CI 1.13-1.33, P = .001, respectively), whereas the risk for PCR was lower with moderate to high myopic target refraction (−6.00 to −1.51 D) (aOR 0.74, 95% CI 0.69-0.79, P < .001). In our discussion, we included possible explanations for these findings, also referring to the related literature. However, we did not postulate that target refraction is interchangeable with biometric parameters such as axial length, as stated by Galvis et al. As mentioned in the article, our analysis was limited to the parameters included in the registry. We agree that analyzing the relationship between biometric parameters and intraoperative complications, such as PCR, is valuable and endeavor to include these in the European Registry of Quality Outcomes for Cataract and Refractive Surgery. Our findings also suggest that there is room to specify further preoperative risk factors, such as previous intravitreal injections or the use of medication that causes intraoperative floppy-iris syndrome. However, it is important to bear in mind that cataract surgery is a high-volume surgery, and adding parameters increases the burden on those who report their data.