Whole population trends in complications of cataract surgery over 22 years in Western Australia

Abstract

Objective: To examine the trends in major complications of cataract surgery in the Western Australian population over 22 years.

Design: Population-based study.

Participants: We included 129 982 cataract/lens surgery patients across 46 health facilities.

Methods: Using the Western Australian Data Linkage System, we identified all patients who underwent cataract/lens surgery in Western Australia between 1980 and 2001. Complications of interest were identified from those patients admitted to hospital or who underwent unplanned surgery after cataract surgery and were validated by medical record review.

Main outcome measures: Admission for retinal detachment, dropped nucleus, wound dehiscence, pseudophakic corneal edema, intraocular lens (IOL) dislocation, and postoperative endophthalmitis requiring surgery.

Results: There were 129 982 cataract/lens procedures and 2087 (1.6%) complications. Complications fell almost 70% over the study period. Retinal detachment (n = 905; 0.70%) was most common, followed by IOL dislocation (n = 361; 0.28%), endophthalmitis (n = 228; 0.18%), wound dehiscence (n = 227; 0.17%), pseudophakic corneal edema (n = 207; 0.16%), and dropped nucleus (n = 159; 0.12%). The incidence of complications lessened over time, except for IOL dislocations, which has increased since 1995. Overall, the risk of complications after phacoemulsification halved since it was introduced in the late 1990s (incidence rate ratio, 0.52; 95% confidence interval, 0.37-0.74), whereas complications after extracapsular extraction (ECCE) have increased over recent years.

Conclusions: Cataract surgery remains an extremely safe procedure with comparatively few major complications. Changes in operative techniques have been accompanied by a significant decrease in complication rates over time, although the increase in IOL dislocations and complications after ECCE warrants further study.

Financial disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.