Visual Outcomes and Postoperative Complications of Eyes with Dropped Lens Fragments During Cataract Surgery: A Multicenter Database Study.

Abstract

To analyze the visual outcomes and postoperative complications of phacoemulsification cataract surgery in eyes with posterior capsule rupture (PCR) and dropped lens fragments (DLF) in comparison to a reference group with uneventful surgery. Eight United Kingdom National Health Service departments. Retrospective comparative non-randomized study. Demographic, medical history, and ocular examination data were automatically extracted from the electronic records. The main outcome variables were postoperative visual acuity (VA), and the development of postoperative cystoid macular edema (CME) as well as rhegmatogenous retinal detachment (RRD) and epiretinal membrane (ERM) requiring surgery. The analysis included 175,589 eyes in the reference group, 2,751 eyes in the PCR group, and 519 eyes in the DLF group. During all postoperative intervals, the mean VA in the DLF and PCR groups was significantly worse than the reference group (p<0.001). On multivariate analysis, the odds of having a VA ≤ 0.3 logMAR at 4-12 weeks postoperatively among eyes with DLF and PCR were 88% and 73% lower than the reference group (p<0.001). More eyes developed CME in the DLF and PCR groups (p<0.001). The odds of requiring RRD and ERM surgery were 3.6 and 2.1 times higher in the DLF group, and 1.8 and 1.3 times higher in the PCR group, respectively, as compared to the reference group. Eyes undergoing phacoemulsification complicated by PCR, and more so with DLF, have worse visual outcomes and higher chances of CME, ERM, and RRD when compared to uneventful surgery.