OBJECTIVES: Posterior capsule opacification (PCO) is the most common complication post cataract surgery and its impact on patients’ vision include reduced visual acuity, impaired contrast and glare disability. This study identified the potential factors associated with the development of PCO following cataract surgery, utilising medical records of cataract patients in the UK.

METHODS: Patients aged ≥65 years who underwent cataract surgery between 2010-2013 with in-the-bag placement of standard monofocal, acrylic intraocular lenses (IOLs) were identified. Electronic medical records (EMR) data from 7 UK NHS clinics was curated for the analyses. Multivariate logistic regression was used to model the risk of PCO adjusting for patient demographics, clinical and IOL characteristics, and surgery-related factors. Data was subset into training (60%) and validation (40%) based on data collection sites. Various models were then estimated and validated on these datasets with different combinations of adjusting covariates. The best fitting model was retained and the results are presented below.

RESULTS: The study included 52,162 eyes (39,324 patients). The variables that were found to be significantly associated (p<0.05) with a higher risk of PCO were presence of post-operative complications (OR 7.2), hydrophilic IOL (OR 3.4), presence of co-pathologies including glaucoma (OR 1.7), retinal vascular occlusion (OR 1.5) and diabetic retinopathy (OR 1.4), larger pupil size (OR 1.3 per unit increase), female sex (OR 1.2) and year of cataract surgery (OR 1.3 for 2012 vs 2010). Edge characteristics (360 vs. non-360) appeared not to be associated with increased risk of PCO (P=0.827).

CONCLUSIONS: The study confirmed that PCO is a multifactorial complication post-cataract surgery, which is affected by several factors including IOL characteristics, baseline demographics, co-pathologies and post-operative complications. These findings suggest that implantation of a hydrophilic IOL and presence of post-operative complications appear to have the largest impact on the increased risk of PCO.