Long-term visual outcomes of immediate versus delayed IOL implantation after posterior capsular rupture: A retrospective study

Abstract

Aim

To evaluate long-term postoperative visual outcomes and safety profile comparing immediate surgical treatment versus delayed management (more than one day) following posterior capsular rupture during cataract surgery.

Material and Methods

This retrospective cohort study included 154 eyes with posterior capsular rupture treated at Fondation Rothschild Hospital, Paris, from March 2022 to June 2023. Patients were divided into two groups: immediate management (same day, n = 117) and delayed management (>1 day, n = 37). Primary outcome was final corrected visual acuity. Secondary outcomes included postoperative complications, refractive outcomes, and intraocular lens (IOL) positioning.

Results

The delayed group showed significantly higher rates of posterior vitrectomy (91.89% vs 21.37%, p < 0.001), iris/scleral fixated IOLs (21.62% vs 4.27%, p = 0.003), and multiple surgical interventions (2.35 ± 0.72 vs 1.20 ± 0.55, p < 0.001). Despite these differences, final visual acuity showed no statistically significant difference between groups (0.298 ± 0.364 vs 0.203 ± 0.308 LogMAR, p = 0.140). Multivariate analysis confirmed no association between timing of intervention and long-term visual acuity (OR: 1.58 [0.535–4.65], p = 0.409). Endothelial decompensation was significantly higher in the delayed group (8.11% vs 0.85%, p = 0.043), while other complications showed no significant differences.

Conclusion

Delayed IOL implantation following posterior capsular rupture can achieve satisfactory long-term visual outcomes comparable to immediate management, despite involving more complex cases requiring advanced surgical techniques. However, the increased risk of endothelial decompensation warrants careful monitoring. These findings suggest that delayed management is a viable option when immediate intervention is not feasible or optimal.