|LETTER TO THE EDITOR
|Year : 2023 | Volume
| Issue : 1 | Page : 21
Rates and risk factors for posterior capsular rent in small-incision cataract surgery in postgraduation training institute
Josephine S Christy, Megha Nair
Department of Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India
|Date of Submission||24-Apr-2023|
|Date of Acceptance||27-May-2023|
|Date of Web Publication||27-Jun-2023|
Aravind Eye Hospital, Cuddalore Main Road, Thavalakuppam, Puducherry - 605 007
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Christy JS, Nair M. Rates and risk factors for posterior capsular rent in small-incision cataract surgery in postgraduation training institute. Pan Am J Ophthalmol 2023;5:21
|How to cite this URL:|
Christy JS, Nair M. Rates and risk factors for posterior capsular rent in small-incision cataract surgery in postgraduation training institute. Pan Am J Ophthalmol [serial online] 2023 [cited 2023 Sep 27];5:21. Available from: https://www.thepajo.org/text.asp?2023/5/1/21/379761
This is based on an interesting article by Pradeep et al. on rates and risk factors for posterior capsular rent (PCR) in small-incision cataract surgery. PCR is a potential sight-threatening complication that occurs during cataract surgery. Despite numerous preventive measures, a PCR can occur, both in the hands of experienced and novice surgeons. However, appropriate intervention at the right time can greatly reduce the risk of sight-threatening complications due to PCR. Therefore, it is imperative to identify the risk factors for PCR, as it helps in better planning to be prepared for intraoperative surprises and, thereby, improving visual outcomes.
It was noted in the study that 66.7% of PCR rates were in people aged more than 65 years, which was concurrent with the study by Narendran et al., which stated that there is a steady increase in PCR rates with increasing age. The large multicentric audit by Narendran et al. also noted that white/brunescent cataracts, small pupil size, and pseudoexfoliation (PXF) are potential risk factors. However, the present study did not show any significant association with grade/type of cataract, size of pupil, or PXF. Possible reasons for this could be the greater number of immature cataracts being operated and also the study lacks proper statistical association tests. Hence, these preoperative factors cannot be completely ruled out as nonrisk factors for PCR.
The comment on gender rates is biased as the complication rates have to be calculated in proportion to the total cataracts operated during the study period rather than just analyzing the subgroup with PCR.
The study mentioned a high occurrence of PCR in patients with posterior subcapsular cataract (PSCC), accounting for 49%. However, the article does not mention the presence of posterior polar cataract (PPC) or PSCC with PPC component. PPC has a greater risk for PCR and possible nucleus drop during surgery. This is due to the strong adherence of PPC to the posterior capsule or posterior capsular dehiscence.
The rate of PCR among resident trainees (1.96%) was higher than that of experienced surgeons (1.46%) in the study and this trend was similar to other studies. The study by Grinton et al. discusses the cause of increased PCR rates among resident trainees as part of the learning curve, lack of experience, late identification, and management of PCR. Being a retrospective study, the authors could have categorized the occurrence of PCR according to the trainee's and consultant's years of experience, which could have shed light on the importance of skill and training in the incidence of complication rates.
Postoperative day vision was low on PCR patients on the next day due to corneal edema, inflammation, and raised intraocular pressure, which was similar to other studies. However, it is important to remember that most cases improve during the course. Hence, it is unfair to conclude on postoperative outcomes with just 1-day postoperative visual result.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Pradeep TG, Namrata D, Thomas AM. Rate and risk factors for posterior capsular rent in small incision cataract surgery in a teaching hospital. Pan Am J Ophthalmol 2022;4:12. [Full text]
Chakrabarti A, Nazm N. Posterior capsular rent: Prevention and management. Indian J Ophthalmol 2017;65:1359-69.
] [Full text]
Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, et al.
The Cataract national dataset electronic multicentre audit of 55,567 operations: Risk stratification for posterior capsule rupture and vitreous loss. Eye (Lond) 2009;23:31-7.
Kalantan H. Posterior polar cataract: A review. Saudi J Ophthalmol 2012;26:41-9.
Grinton M, Sandhu J, Shwe-Tin A, Steel DH, Ting DS, North East Trainee Research in Ophthalmology Network (NETRiON). Incidence, characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: An ophthalmology trainees' perspective. Eye (Lond) 2021;35:1213-20.