Risk Factors Of Posterior Capsule Rupture In Phacoemulsification

ObjectiveTo analyze the risk factors of posterior capsule rupture(PCR)in phacoemulsification,and to provide countermeasures to prevent the occurrence of PCR in phacoemulsification and improve the prognosis.Methods5 415 patients(5 743 eyes)who underwent phacoemulsification combined with intraocular lens(IOL)implantation in Fengxian District Hospital of Traditional Chinese Medicine from Jan.2011 to Dec.2017 were selected as the study objects.All operations are performed by the same experienced surgeon.120 eyes of 105 patients with intraoperative lens PCR were selected as the PCR group,and 480 eyes of 452 patients were randomly selected as the control group according to the ratio of 1:4.The information which was compared between 2 groups was compised of basic factors of all patients(age,gender),systemic risk factors(hypertension,diabetes,cardiovascular disease,history of glucocorticoid use,smoking,drinking),basic ophthalmic information(eye separation,preoperative visual acuity,preoperative intraocular pressure,axial length of eye),ophthalmic risk factors(history of glaucoma,history of high myopia,history of keratopathy,history of uveitis,,history of vitreous surgery),as well as cataract nucleus hardness.To analyze the risk factors of PCR in phacoemulsification by statistical analysis of all data.ResultsThe ratios of eyes with preoperative visual acuity of log MAR >1.0 [89.2%(107/120)vs 58.1%(279/480)],and vitreous operation history [20.8%(25/120)vs 4.8%(23/480)] in PCR group were all higher than those in control group.The difference is statistically significant(P < 0.05).The axial length of the eyes in the two groups was divided into short axial(AL < 22mm),middle axial(22mm ? AL ? 26mm)and long axial(AL > 26mm).54 eyes(45.0%),31 eyes(25.8%)and 35 eyes(29.2%)in the PCR group,46 eyes(9.6%),376 eyes(78.3%)and 58 eyes(12.1%)in the control group.There was a significant difference in the distribution of axial length between the two groups(P < 0.001).The incidence of PCR was significantly higher in the PCR group when the axial length was shorter(AL < 22mm).According to emery's nuclear grading standard,111 eyes(97 patients)in the PCR group and 459 eyes(431 patients)in the control group were graded for lens nuclear hardness.The hardness of lens nucleus in the PCR group was 9 eyes(8.1%)of grade I,11 eyes(9.9%)of grade II,10 eyes(9.0%)of grade III,46 eyes(41.4%)of grade IV and 35 eyes(31.5%)of grade V,while in the control group,88 eyes(19.2%)of grade I,82 eyes(17.9%)of grade II,109 eyes(23.7%)of grade III,97 eyes(21.1%)of grade IV and 83 eyes(18.1%)of grade V,respectively.The difference between the two groups was statistically significant(P <0.001).In PCR group,the higher the nuclear grade was,especially when it was larger than grade III(grade IV and grade V),the higher the incidence of PCR was.The visual acuity of log MAR was restored from 2.11±0.98 to 1.07±0.44 in the PCR group,The difference of the visual acuity of log MAR was statistically significant(P <0.001).The visual acuity of log MAR was restored from 1.37±0.90 to 0.72±0.37 in the control group,The difference of the visual acuity of log MAR was statistically significant(P <0.001).The visual acuity of Log MAR in the PCR group was worse than that in the control group(preoperative : P < 0.001;postoperative: P < 0.001).Multivariate logistic regression analysis showed that preoperative visual acuity of log MAR >1.0,axial length of eye(AL<22mm),vitreous operation history and lens nucleus hardness grade(?grade IV)were risk factors of PCR in phacoemulsification.Conclusion1.Preoperative visual acuity of log MAR >1.0,axial length of eye(AL<22mm),vitreous operation history and lens nucleus hardness grade(?grade IV)are the risk factors of PCR in phacoemulsification.2.Ophthalmologists should evaluate the risk factors of PCR,and then improve the operation plan to minimize the incidence of PCR and improve the visual function of patients.