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Capsule complications in Sweden fell stabilized between 2002 and 2009
Improved technology and surgical techniques likely led to the decrease in complications.
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The nationwide incidence of capsule complications in Sweden steadily diminished and leveled off during the last decade, a large study found.
Data were culled from the Swedish National Cataract Register (NCR), which began to include posterior capsule complications in 2002.
“The most significant findings were the decreasing rate of capsule complications over time and also a decrease of risk factors,” Mats Lundström, MD, PhD, corresponding study author, said in an email interview with Ocular Surgery News.
The steady decrease and subsequent stabilization of capsule complications may also be attributed to improvements in surgical methods, Dr. Lundström said. More specifically, the reduction in complications was linked, at least in part, to improved capsulorrhexis techniques, newer phacoemulsification technology and safer probes, he said.
The study was published in the Journal of Cataract and Refractive Surgery.
Population and methods
The NCR included 97.3% of total cataract procedures performed in Sweden, the authors said.
A total of 603,881 cataract procedures were collected prospectively in the NCR between 2002 and 2009. Data were missing from 1,328 cases, which were excluded from the analysis. The final analysis included 602,553 procedures.
A subset analysis designed to validate the larger database included a randomly selected sample of 2,400 procedures performed between 2002 and 2006; data were available for 2,276 cases included in the subset.
Phacoemulsification was performed in 594,744 cases (98.9%), and foldable IOLs were implanted in 596,817 cases (99.2%). The rate of cataract surgery between 2000 and 2009 ranged from 8,000 to 9,000 surgeries per 1 million residents, the data showed.
Best corrected visual acuity rather than cataract density grade was used to determine the presence of dense cataracts.
“Poor visual acuity and age were both associated with a capsule complication, and when we performed regression analysis, each variable was associated with the risk of capsule complication,” Dr. Lundström said. “Poor visual acuity [correlated with complications] more strongly than high age.”
Results and analysis
Data showed that capsule complications were reported in 12,574 cases (2.09%). The incidence of capsule complications declined from 2.8% in 2002 to 1.77% in 2006, then leveled off at 1.89% in 2007, 1.68% in 2008 and 1.61% in 2009.
Poor distance visual acuity in the surgical eye, glaucoma, diabetic retinopathy and age correlated most prominently with capsule complications.
Subset analysis showed an incidence of posterior capsule complications of 2.72% between 2002 and 2006. The incidence was statistically comparable to the 2.3% incidence seen in the 2002 to 2006 database.
The analysis showed some underreporting of capsule complications; however, the discrepancy was insignificant, the authors said.
Dr. Lundström and colleagues noted a strong correlation between surgical volume and incidence of complications. High-volume clinics, those with more than 16,000 procedures during the study period, had an incidence of 1.89%. Medium-volume clinics, those with 8,000 to 15,999 procedures, had an incidence of 1.95%. Low-volume clinics, those with fewer than 8,000 procedures, had an incidence of 2.94%.
Ongoing innovations, such as femtosecond laser-assisted cataract surgery, are likely to further reduce the incidence of posterior capsule complications by enabling improvements in capsulorrhexis design, incisions and lens fragmentation, Dr. Lundström said.
“However, the [irrigation-aspiration] procedure is well known as a risky moment for capsule complications, and we still have to do that procedure with femto technique,” he said. – by Matt Hasson
Reference:
- Lundström M, Behndig A, Kugelberg M, Montan P, Stenevi U, Thorburn W. Decreasing rate of capsule complications in cataract surgery: eight-year study of incidence, risk factors, and data validity by the Swedish National Cataract Register. J Cataract Refract Surg. 2011;37(10):1762-1767.
For more information:
- Mats Lundström, MD, PhD, can be reached at EyeNet Sweden, Blekinge Hospital, SE-371 85 Karlskrona, Sweden; email: mats.lundstrom@ltblekinge.se.
- Disclosure: Dr. Lundström has no relevant financial disclosures.
Perspective
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John A. Hovanesian, MD, FACS
This study, performed in a well-defined Swedish population, nicely characterizes a trend toward lower capsular complication rates in cataract surgery that has been anecdotally observed by many experienced cataract surgeons over the past 10 years. New developments in cataract extraction machinery and fluidics and better hand instruments and implant injectors probably explain this trend. As the population of patients desiring cataract surgery becomes younger, and the stage of cataracts at the time of extraction becomes earlier, it is reassuring to see that surgery is appropriately becoming safer.
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