{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:18:23Z","timestamp":1787681903266,"version":"build-2784847793"},"reference-count":23,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,8,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To investigate whether phacoemulsification platform type and phaco tip design are associated with differences in unadjusted posterior capsular rupture (PCR) rates in cataract surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study used centre-level data from UK National Health Service (NHS) cataract surgery centres included in the 2024 National Ophthalmology Database Cataract Audit, with a complementary analysis from two tertiary NHS centres. Phacoemulsification platform and principal tip design were identified by contacting each centre. Unadjusted PCR rates were compared using \u03c7\u00b2 tests with ORs and 95% CIs. A separate eye-level analysis assessed the association between tip design and PCR after adjusting for surgeon experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-four NHS centres contributed 166\u2009213 cataract operations, with a mean unadjusted PCR rate of 1.48% (SD 0.61%). Among 44\u2009202 procedures, Alcon systems accounted for 25\u2009921 cases with 462 PCRs (1.78%), while Bausch &amp; Lomb systems accounted for 18\u2009281 cases with 202 PCRs (1.10%) (OR 1.62, 95% CI 1.38 to 1.92; p&lt;0.0001). Flared tips were associated with higher unadjusted PCR rates than straight tips (2.12% vs 1.30%; OR 1.64, 95% CI 1.40 to 1.93; p&lt;0.0001). In the local eye-level cohort, flared tips remained associated with higher odds of PCR after adjustment for surgeon experience (OR 2.33, 95% CI 1.18 to 5.13).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this national audit sample, phacoemulsification platform and tip architecture were associated with differences in unadjusted PCR rates. Similar associations were observed in a complementary eye-level analysis adjusting for surgeon experience. Given the unadjusted nature of the data and the lack of adjustment for case complexity, surgical technique, training and fluidics configuration, these findings should be interpreted with caution, and further prospective risk-adjusted studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-330295","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:20:11Z","timestamp":1787678411000},"page":"bjo-2026-330295","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Posterior capsular rupture and phacoemulsification device"],"prefix":"10.1136","author":[{"given":"Mahmoud","family":"Ahmed","sequence":"first","affiliation":[{"name":"St Paul\u2019s Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0215-5624","authenticated-orcid":false,"given":"Maria Laura","family":"Passaro","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences \u2018V.Tiberio\u2019, University of Molise, Campobasso, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0390-0592","authenticated-orcid":false,"given":"Stephen B","family":"Kaye","sequence":"additional","affiliation":[{"name":"Department of Eye and Vision Science, University of Liverpool, Liverpool, UK"},{"name":"Royal Liverpool University Hospital, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026082510200600000_bjo-2026-330295v1.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2015-307729"},{"key":"2026082510200600000_bjo-2026-330295v1.2","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/aos.17467","article-title":"Cataract surgery in megalocornea: A qualitative and quantitative evaluation of published literature","volume":"103","author":"Vaccaro","year":"2025","journal-title":"Acta Ophthalmol"},{"key":"2026082510200600000_bjo-2026-330295v1.3","doi-asserted-by":"crossref","DOI":"10.5935\/0004-2749.2024-0328","article-title":"Clinical features, management, and outcomes of posterior capsule rupture during phacoemulsification surgery","volume":"88","author":"Koser","year":"2025","journal-title":"Arq Bras Oftalmol"},{"key":"2026082510200600000_bjo-2026-330295v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/bjo-2024-326592"},{"key":"2026082510200600000_bjo-2026-330295v1.5","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/eye.2015.3","article-title":"The Royal College of Ophthalmologists\u2019 National Ophthalmology Database study of cataract surgery: report 1, visual outcomes and complications","volume":"29","author":"Day","year":"2015","journal-title":"Eye (Lond)"},{"key":"2026082510200600000_bjo-2026-330295v1.6","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1038\/s41433-020-1057-z","article-title":"Incidence, characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: an ophthalmology trainees\u2019 perspective","volume":"35","author":"Grinton","year":"2021","journal-title":"Eye (Lond)"},{"key":"2026082510200600000_bjo-2026-330295v1.7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/sj.eye.6703049","article-title":"The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss","volume":"23","author":"Narendran","year":"2009","journal-title":"Eye (Lond)"},{"key":"2026082510200600000_bjo-2026-330295v1.8","doi-asserted-by":"crossref","first-page":"3495","DOI":"10.1038\/s41433-024-03344-2","article-title":"The Royal College of Ophthalmologists\u2019 National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture","volume":"38","author":"Sim","year":"2024","journal-title":"Eye (Lond)"},{"key":"2026082510200600000_bjo-2026-330295v1.9","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1038\/s41433-019-0389-z","article-title":"The Royal College of Ophthalmologists\u2019 National Ophthalmology Database Study of cataract surgery. 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