The approach suggested by Ho and Claoue1 of using the rate of posterior capsule rupture (PCR) during cataract surgery as a surrogate marker for competency in cataract surgery for surgeons who are not in training programmes is a reasonable one. The occurrence of PCR considerably increases the likelihood of further complications and a poorer than expected visual outcome. A model has also been proposed for the adjustment of PCR rates to take account of known preoperative risk factors, which can increase the risk of PCT by a factor of 50 or more.2
However, considerable caution is required when interpreting the rate of an adverse event when the number of operations performed is small. A second occurrence of PCR in a sample of 50 cataract operations doubles the rate from 2% to 4%, for example. It is therefore important to consider not just the rate of PCR but the clinical course following each occurrence of PCR. If the complication is not recognized or not managed adequately during the procedure, the risk of further complications (e.g. macular oedema, retinal detachment) and a poor visual outcome increases greatly.
Competing interests
None declared
References
- 1.Ho J, Claoué C Cataract skills: how do we judge competency? J R Soc Med 2013;106:2–4 doi:10.1177/0141076813476412 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sparrow JM, Taylor H, Qureshi K, Smith R, Johnston RL The cataract national data set electronic multi-centre audit of 55 567 operations: case mix adjusted surgeon's outcomes for posterior capsule rupture. Eye 2011;25:1010–15 [DOI] [PMC free article] [PubMed] [Google Scholar]