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The Malaysian Cataract Surgery Registry: risk Indicators for posterior capsular rupture
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  • Published on: 25 October 2017
    Higher posterior capsular rupture rates in male patients
    • Zaid Shalchi, Locum Consultant Ophthalmic Surgeon Moorfields Eye Hospital
    • Other Contributors:
      • Mali Okada, Clinical Research Fellow
      • Chris Whiting, Deputy Head of Information
      • Robin Hamilton, Consultant Ophthalmic Surgeon

    We read with great interest the study by Salowi and colleagues,[1] analysing risk factors for posterior capsular rupture (PCR) in over 150,000 cataract operations across Malaysia. Many of the significant risk factors were expected and well-recognised, such as junior surgeon or pseudoexfoliation. An interesting finding was increased PCR in males, with odd ratio 1.11 (95% confidence interval 1.04 to 1.17).

    Male gender has been found to be a risk factor for PCR in other large retrospective studies. The Cataract National Dataset of 55,567 cataract operations across 12 National Health Service Trusts in the UK found male gender to have an adjusted odds ratio of 1.28 (95% CI 1.13-1.45).[2] We recently reviewed 62,994 cataract operations performed at Moorfields, showing male gender as a significant risk for PCR, with OR 1.490 (95% CI 1.274–1.741).[3] This risk was similar to junior surgeon (OR 1.483) or prior intravitreal injection (OR 1.664), an increasingly acknowledged predictor of complicated surgery.

    The reasons for increased PCR in male patients is unclear. Males are significantly more likely to take tamsulosin, an alpha receptor blocker used in the treatment of benign prostatic hypertrophy. This can lead to poor pupillary dilation and intraoperative floppy iris syndrome (IFIS).[4] Although this can be effectively managed with intracameral phenylephrine, iris hooks or Malyugin ring, it remains a risk factor for PCR. Furthermore, males are more likely to be aff...

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    Conflict of Interest:
    Robin Hamilton has received honoraria from Novartis, Bayer, Allergan and Ellex. Zaid Shalchi has received honoraria from Bayer. The following authors have no financial disclosures: Mali Okada, and Chris Whiting.