Posterior Capsule Rupture and Vitreous Loss in Cataract Surgery: A Retrospective Analysis from a Swiss Tertiary Center

Tahm Spitznagel,1,2 Gábor Márk Somfai,1– 3 Ferhat Turgut,1– 4 Paul Kang,5 Toam Katz,6,7 Sophie-Christin Kornelia Ernst,1,2,8 Ute Hornberger,1,2 Matthias Dieter Becker,1,2,9 Florian Heussen,10 Michaela Ramsauer1,2 1Department of Ophthalmology, Stadtspital Zürich, Zurich, Switzerland; 2Spross Research Institute, Zurich, Switzerland; 3Department of Ophthalmology, Semmelweis University, Budapest, Hungary; 4Gutblick Research, Pfäffikon, Switzerland; 5University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA; 6EuroEyes, Zurich, Switzerland; 7Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 8Department of Ophthalmology, Basel University Hospital, Basel, Switzerland; 9Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany; 10Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, SwitzerlandCorrespondence: Michaela Ramsauer, Department of Ophthalmology, Stadtspital Zürich, Birmensdorferstrasse 497, Zürich, 8063, Switzerland, Email [email protected]: To determine the incidence of posterior capsule rupture (PCR) and vitreous loss (VL) during cataract surgery in a Swiss tertiary care center. Furthermore, we aimed to evaluate preoperative risk factors associated with PCR/VL, including pseudoexfoliation (PEX), age, type of anesthesia, and the Triemli Cataract Score (TCS), a locally implemented preoperative risk assessment tool for surgical complexity.Methods: This retrospective single-center cohort study included all phacoemulsification and refractive lens exchange procedures performed at Stadtspital Zürich between January 2021 and late August 2024. Data were retrieved from the Dendrite clinical database of the TCS and supplemented through manual chart review and surgical reports for identification of intraoperative complications. Univariable and multivariable logistic regression analyses were performed to evaluate associations between preoperative factors and the occurrence of PCR and/or VL.Results: A total of 2’ 719 eyes were included in the study. PCR and/or VL occurred in 52 eyes (1.9%), including 45 cases of PCR (5 with concomitant VL) and 7 additional cases of isolated VL due to zonulolysis. In univariate analysis, PEX and a TCS ≥ 3 were significantly associated with an increased risk of PCR and/or VL (OR 2.72; p=0.003 and OR 2.38; p=0.002, respectively), while topical (vs. general) anesthesia was associated with a reduced risk (OR 0.51, p=0.019). In multivariate analysis, only PEX remained an independent risk factor (OR 2.38; p=0.013). The association between TCS ≥ 3 and PCR/VL just missed statistical significance (OR 1.79; p=0.057).Conclusion: The rate of PCR and/or VL during cataract surgery at a Swiss tertiary care center is comparable to international statistics. PEX is a strong and independent predictor for these complications; although the predictive power of TCS did not reach statistical significance in multivariable analysis, the observed trend suggests that risk-based preoperative scores such as the TCS may support risk-stratification and surgical planning in clinical practice.Keywords: surgical complications, triemli cataract score, phacoemulsification, risk factors