Visual Outcomes and Risk of Rhegmatogenous Retinal Detachment Following Posterior Capsule Rupture during Cataract Surgery: With vs without Dropped Nuclear Lens Fragments

Background: Cataract surgery is the most frequently performed surgery worldwide. Posterior capsule rupture (PCR) remains one of the most common complications of cataract surgery and a major risk factor for poor visual outcomes. Cataract surgeries complicated by PCR and vitreous loss are managed with anterior vitrectomy at the time of surgery. However, the situation can be further complicated by dropping lens particles into the vitreous cavity necessitating a secondary pars plana vitrectomy (PPV). Purpose: To compare the visual outcomes and risk of rhegmatogenous retinal detachment (RRD) between eyes that required anterior vitrectomy (AV) alone for the management of vitreous loss and eyes that required AV and subsequent PPV for the management of dropped nuclear lens fragments (DNLF) following cataract surgery complicated by PCR in a tertiary care teaching hospital in Saudi Arabia. Methods: Medical records of patients in whom PCR occurred during phacoemulsification cataract surgery requiring AV or subsequent PPV for DNLF were retrospectively reviewed over a 6-year period from January 2016 to December 2021. Results: PCR occurred in 183 (2.3%) of 7757 consecutive eyes that underwent phacoemulsification cataract surgery during the study period. Seven eyes were excluded from analysis for missing data or short follow-up. Of the 176 eyes, 147 eyes (83.5%) were managed with AV alone, and the remaining 29 eyes (16.5%) underwent a secondary PPV for DNLF. After excluding eyes with pre-existing ocular pathology, final best-corrected visual acuity (BCVA) was similar in both groups with a mean of 0.32 logMAR (P = 0.99). Two of 147 eyes (1.4%) in the AV group developed RRD with poor final BCVA whereas none of the eyes in DNLF group developed RRD. Conclusion: The risk of RRD is lower in eyes that required PPV for DNLF than in eyes that were managed with AV alone following PCR during cataract surgery. The poor visual outcomes in eyes that suffered RRD underscore the importance of postoperative retinal examination and early detection of retinal breaks.