ASSESSMENT OF PREOPERATIVE AND INTRAOPERATIVE RISK FACTORS OF POSTERIOR CAPSULAR OPACIFICATION

Abstract

Background and Objective Posterior capsular opacification (PCO) is a common complication following cataract surgery, significantly impacting patients visual acuity and quality of life. Modern advancements in ocular surgery, including intraocular lens (IOL) implantation and cataractous lens extraction, have improved postoperative outcomes, allowing patients to regain clear vision. But even after surgery, PCO can develop months or years later, and this continues to be a major obstacle to visual recovery. This study aims to identify the preoperative and intraoperative risk factors associated with PCO, focusing on age, diabetes status, oral steroid use, cataract type, IOL type and placement, capsulorrhexis size and surgical techniques. Methods In this prospective, cross-sectional study, 71 patients with cataracts noticed that their eyesight was decreased, and they had surgery. These patients were under observation for six months, after surgery throughout that period they visited the outpatient ophthalmology department of the R. L. Jalappa Hospital and Research Centre in Tamaka, Kolar. The hospital is affiliated with Sri Devaraj URS Medical College. September 2022 to December 2023 was the study period. Results Out of the 71 patients, 9.9% were under 40 years, 43.7% were aged 41-60 years, 43.7% were aged 61-80 years, and 2.8% were over 80 years. The study population included 39.4% males and 60.6% females, with 54.9% right-eye and 45.1% left-eye cases. Mature cataracts were present in 23.9% of patients, Nuclear sclerotic cataracts in 7.0%, Posterior polar cataracts in 5.6%, and Posterior subcapsular cataracts in 63.4%. The incidence of PCO was higher in xv younger patients, with 100% in those under 40 years, 78.6% in the 40-59 age group, and 78.4% in those over 60 years. Among non-diabetic patients, 80.4% developed PCO, while 80.0% of diabetic patients did. All patients taking oral steroids developed PCO, compared to 77.4% of non-users. None of the patients with acrylic IOLs developed PCO, whereas 79.1% with PMMA IOLs did. PCO was observed in 78.3% of patients with IOLs placed in the capsular bag and 90.9% with IOLs in the sulcus. All phacoemulsification cases developed PCO, compared to 76.7% of SICS cases. PCO incidence was 77.8% in patients with a 5.5 mm size of capsulorrhexis and 81.8% in those with a 6 mm size of capsulorrhexis. PCO development was observed as early as one-month post-surgery, with the majority of cases occurring within six months. Conclusion and interpretation This study underscores the significance of both preoperative and intraoperative factors in the development of PCO. Younger patients, especially those under 40, have a higher likelihood of developing PCO. Key preoperative risk factors include oral steroid use, diabetes, and the grade of the cataract. Intraoperative factors, such as the size of capsulorrhexis, proper hydrodissection, and thorough cortical wash, are modifiable and can greatly influence the development of PCO. Placing an intraocular lens (IOL) in the capsular bag is preferable to sulcus implantation to lower the risk of PCO. Our findings indicate that 57 out of 71 cases developed PCO within six months, with some instances occurring as early as one-month postsurgery. This contrasts with previous studies that suggested PCO as a late complication. Overall, this study provides valuable insights for improving patient outcomes by addressing both preoperative and intraoperative risk factors to reduce the incidence of PCO.