The Royal College of Ophthalmologists' National ophthalmology database study of cataract surgery: Report 14, cohort analysis - the impact of CapsuleGuard® utilisation on cataract surgery posterior capsule rupture rates

Background/Objectives: The aim of this study was to investigate whether the use of the silicone tipped irrigation/aspiration (I/A) handpiece CapsuleGuard (R) (Bausch + Lomb, Laval, Canada) reduced rates of posterior capsule rupture (PCR) during cataract surgery. Methods: Royal College of Ophthalmologists' National Ophthalmology Database (NOD) Cataract Audit data from 01/04/2010 and 31/03/2021 and Bausch + Lomb sales figures were combined to identify centres participating in national cataract audit who have routinely adopted the silicone tipped I/A handpiece, CapsuleGuard (R). Data were included only from centres with eligible cataract operations recorded on the NOD both before and after adopting CapsuleGuard (R). Review of the literature was undertaken to estimate the proportion of PCR that occurs during I/A, to evaluate the impact of adoption of CapsuleGuard (R) on PCR occurring in this phase of surgery. Results: Within the study period, 267 371 eligible cataract operations were performed in 14 centres with >50 eligible operations both before and after adopting CapsuleGuard (R). Within centres adopting CapsuleGuard (R), the rate of PCR occurrence reduction was 16.4%. Before and after the adoption of CapsuleGuard (R) the median change of PCR was 21.7% reduction (IQR: 4.8% to 37.7% reduction). Conclusions: A reduction in the rate of PCR was seen after regular adoption of CapsuleGuard (R) during cataract operations. Review of published studies attributing PCR to various components of the cataract operation suggest around 25% of PCR may occur during I/A; adoption of CapsuleGuard may, therefore, be associated with avoidance of a substantial proportion of the PCR during that phase of surgery.