The effect of surgical abstinence on the risk of posterior capsule rupture during cataract surgery

Matarazzo, Francesco; Phylactou, Maria; Day, Alexander C; Maurino, Vincenzo

PURPOSE: To evaluate the impact of surgery restrictions on cataract surgery performance. SETTING: Moorfields Eye Hospital, NHS Foundation Trust, London, UK. DESIGN: Retrospective, observational cross-sectional study. METHODS: Single-centre, retrospective review of all patients that underwent phacoemulsification surgery at Moorfields Eye Hospital, between September 2019 and January 2021. Our main outcome measure was Posterior Capsule Rupture (PCR) rate before and after COVID-19 imposed restrictions to elective cataract surgery. RESULTS: We identified a total of 15689 surgeries in the period of the study performed by 256 different surgeons. In the pre-surgery restriction period (September 2019 to March 2020), the PCR rate was 0.99% while on surgery restarting after 19 weeks, the PCR rate spiked to 1.62% (Odds Ratio 1.65; p=0.001; CI 1.24-2.20; Relative Risk: 1.64). CONCLUSIONS: COVID-19 pandemic provided a unique opportunity to assess a large group of surgeons' performances after prolonged surgical abstinence. A 19-weeks period of restrictions in surgical activity showed an increased incidence of PCR complications. This is relevant as it can concern any surgeon on extended time off work such as sickness, sabbatical, research and parental leave. Supporting strategies should be implemented by associated regulators to minimize this negative impact.