Posterior capsule rupture during cataract surgery: analysis of visual outcomes and associated risk factors.

OBJECTIVES: To evaluate visual outcomes and identify risk factors for poor visual prognosis and dropped nucleus following posterior capsule rupture (PCR) during cataract surgery over a 5-year period in an Asian tertiary institution. DESIGN: A retrospective chart review. PARTICIPANTS: All eyes that were complicated by PCR during cataract surgery at Tan Tock Seng Hospital, Singapore, between January 2016 and December 2020. METHODS: Medical records were reviewed for demographics, preoperative, intraoperative, and postoperative data. The primary outcome measures were best-corrected visual acuity (BCVA) ≥20/40 at 3 months (short-term visual outcome) and at final follow-up (long-term visual outcome). Logistic regression identified independent predictors of poor visual outcomes and intraoperative dropped nucleus. RESULTS: Among 31,663 phacoemulsification cataract surgeries performed during the study period, 234 (0.74%) were complicated by PCR. Of 211 eyes with PCR analyzed for vision, 191 (90.5%) achieved BCVA ≥20/40 at 3 months, and 174 (83.3%) maintained this at final follow-up (median 35 months). Predictors of poor final vision included increasing age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.00-1.10; p = .042), postoperative complications (OR: 8.17; 95% CI: 3.34-20.56; p < .001), and non-in-the-bag lens status (OR: 3.89; 95% CI: 1.56-9.69; p = 0.003). Dropped nucleus was associated with early PCR (OR: 8.37; 95% CI: 2.39-32.61; p = 0.001) and vitreous loss (OR: 20.66; 95% CI: 3.95-386.89; p = 0.004). CONCLUSIONS: Despite PCR, most patients achieved favourable long-term visual outcomes. Poor long-term visual prognosis was associated with older age, postoperative complications, and non-in-the-bag lens status. Early PCR and vitreous loss were key predictors of dropped nucleus.