Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review

Figures & data

Table 1 PCC patient details

	FLACS 1	FLACS 2	FLACS 3	FLACS 4	FLACS 5	FLACS 6	Manual 1
Age (years)	84	98	85	89	86	67	82
Preoperative SE (D)	+7.00	+3.00	+1.50	+2.50	−1.50	+1.00	+0.5
PXF	No	Yes	No	Yes	Yes	No	No
Other risk factors	No	No	Small	Tamsulosin	No	No	Fuchs’ corneal
			pupil	(Flomax)			dystrophy – hazy cornea
Capsulorhexis size (mm)	4.9	4.9	4.5	4.7	4.9	4.9	5.0

Abbreviations: PCC, posterior capsular complication; FLACS, femtosecond-assisted laser cataract surgery; SE, spherical equivalent; D, diopters; PXF, pseudoexfoliation.

Table 2 Surgical and postoperative values of PCR cohort

	FLACS 1	FLACS 2	FLACS 3	FLACS 4	FLACS 5	FLACS 6	Manual 1
Complication	Vitreous strand protruding from peripheral capsule hole	ZD leading to cortex loss into the vitreous cavity	Split anterior capsule ran posteriorly and nuclear fragment loss into vitreous cavity	Zonule dialysis Anterior hyaloid face intact	Zonule dialysis	Phacoemulsification hole in posterior capsule	Posterior capsular tear during cortical cleanup
Primary vitrectomy	Yes	Yes	No	No	Yes	Yes	No
Lens inserted at primary procedure	Yes	No	No	Yes	Yes	Yes	Yes
Position of	Sulcus	Sulcus	Sulcus	Anterior chamber	Anterior chamber	Capsular bag	Capsular bag
IOL	MA60AC	MA60AC	MA60AC	MTA4UO	MTA4UO	SN60WF
Secondary procedure	No	Yes (remove cortex and place IOL into sulcus)	Yes (remove lens fragment and place IOL)	No	Yes (anterior chamber washout with repositioning of IOL)	No	No

Abbreviations: FLACS, femtosecond-assisted laser cataract surgery; ZD, zonular dialysis; IOL, intraocular lens; PCR, posterior capsular rupture.

Table 3 Published incidence of PCR in conventional surgery

First author (reference)	Journal/year	Sample size (N)	Incidence (%)	Type of practice
Haripriya (17)	Ophthalmology 2017	617,453	1.37	(10) Private
Shalchi (27)	AJO 2017	62,994	1.04	Public
Salowi (6)	BJO 2017	150,213	3.2	(36) Public (including trainees)
Hashemi (35)	Optom Vis Sci 2016	8,727	3.55	(55) Public and private
Day (19)	Eye 2015	180,114	1.95	Public and private
Khanna (36)	Int J Ophthalmol 2015	33,856	0.82	Private
Chen (9)	Clin Ophthalmol 2014	3,339	0.68	Private
Lee (37)	JCRS 2013	2,862	0.77	Public
Ang (38)	JCRS 2006	2,727	1.7
Chan (39)	JCRS 2003	8,230	1.9	Included extracapsular surgery
Pingree (40)	JCRS 1999	1,729	2.54	Academic
Ng (41)	JCRS 1998	1,998	1.4	Public
Mishra (26)	IJO 1983	7,008	3.8	Public (including trainees)

Note: The figures in brackets indicate the number of clinics included in each sample. Abbreviation: PCR, posterior capsular rupture.

Table 4 Published incidence of PCR in FLACS

First author (reference)	Journal/year	Sample size (N)	Incidence (%)	Type of practice
Current study	2017	2,021	0.30	Private
Scott (14)	JCRS 2016	3,371	0.77	Private
Chee (29)	AJO 2015	1,105	0.27
Abell (3)	Ophthalmology 2014	804	0.87	Private
Chang (42)	JCRS 2014	170	0.60	Private
Abell (43)	JCRS 2015	1,852	0.43	Private
Roberts (13)	Ophthalmology 2013	1,300	0.31	Private
Abell (44)	Clin Exp Ophthalmol 2013	200	0.50	Private
Bali (10)	Ophthalmology 2012	200	3.50	Private

Abbreviations: PCR, posterior capsular rupture; FLACS, femtosecond-assisted laser cataract surgery.