Posterior capsular rupture and phacoemulsification device

BACKGROUND: To investigate whether phacoemulsification platform type and phaco tip design are associated with differences in unadjusted posterior capsular rupture (PCR) rates in cataract surgery. METHODS: This retrospective observational study used centre-level data from UK National Health Service (NHS) cataract surgery centres included in the 2024 National Ophthalmology Database Cataract Audit, with a complementary analysis from two tertiary NHS centres. Phacoemulsification platform and principal tip design were identified by contacting each centre. Unadjusted PCR rates were compared using χ² tests with ORs and 95% CIs. A separate eye-level analysis assessed the association between tip design and PCR after adjusting for surgeon experience. RESULTS: Twenty-four NHS centres contributed 166 213 cataract operations, with a mean unadjusted PCR rate of 1.48% (SD 0.61%). Among 44 202 procedures, Alcon systems accounted for 25 921 cases with 462 PCRs (1.78%), while Bausch & Lomb systems accounted for 18 281 cases with 202 PCRs (1.10%) (OR 1.62, 95% CI 1.38 to 1.92; p<0.0001). Flared tips were associated with higher unadjusted PCR rates than straight tips (2.12% vs 1.30%; OR 1.64, 95% CI 1.40 to 1.93; p<0.0001). In the local eye-level cohort, flared tips remained associated with higher odds of PCR after adjustment for surgeon experience (OR 2.33, 95% CI 1.18 to 5.13). CONCLUSIONS: In this national audit sample, phacoemulsification platform and tip architecture were associated with differences in unadjusted PCR rates. Similar associations were observed in a complementary eye-level analysis adjusting for surgeon experience. Given the unadjusted nature of the data and the lack of adjustment for case complexity, surgical technique, training and fluidics configuration, these findings should be interpreted with caution, and further prospective risk-adjusted studies are needed.