Virginija Vilkelyte
Posterior capsule rupture (PCR) is a well-recognised complication of cataract surgery and a key quality indicator in ophthalmic surgical outcomes (1). Conducting an audit on PCR is not only a valuable exercise in clinical governance but also relatively straightforward, making it an excellent opportunity for both ophthalmology trainees and those applying for training to gain audit experience and contribute to improving patient safety.
The National Ophthalmology Database (NOD) actively advocates for all ophthalmology units in the UK to conduct PCR audits annually (2). This initiative is aimed at strengthening national data collection, allowing for benchmarking, and ultimately enhancing surgical outcomes through systemic feedback and comparison. Submitting your centre’s data to the NOD helps build a more comprehensive national picture of surgical performance and contributes to continuous quality improvement across the specialty.
Step-by-Step Guide to Conducting a PCR Audit
1. Understand the National Context
Begin by reviewing the annual NOD Cataract Audit Report. This document outlines the national PCR rate and provides context on the importance of tracking and analysing PCR events. Familiarity with this report will help frame your audit in alignment with national standards.
2. Choose Your Audit Period
While the NOD typically uses the NHS financial year (April to March), you may choose a calendar year (January to December) depending on local preferences or data accessibility. Consistency within your chosen period is key.
3. Register Your Audit
Ensure your audit is registered through your trust’s audit and governance portal. This allows access to institutional support and data services such as Business Intelligence, who can help with metrics like the total number of cataract surgeries.
Data Collection
Identifying PCR Cases
PCRs are usually documented in theatre records or operative notes. Depending on your hospital, data can be found via:
- Electronic theatre logs or operative records
- Manual theatre logbooks (accessible via theatre staff)
- Business intelligence or coding teams
In some centres, you may need to contact consultants or surgical leads directly. If PCRs are not yet formally coded in electronic systems like Epic, consider recommending this as part of your audit to support future data collection.
Surgical Volume
- The total number of cataract surgeries during your audit period can typically be obtained through your hospital’s business intelligence team, clinical audit department, or administrative staff supporting the ophthalmology service.
Feel free to use the table below to aid you in collecting the data:
Calculating PCR Rate
PCR Rate (%) = (Number of PCR Events / Total Cataract Surgeries) × 100
Final Presentation and Recommendations
- Use the NOD-provided PowerPoint templates or your own to present the audit.
- Present your findings at an Information Governance Meeting or clinical governance session.
- Consider including a data improvement strategy, such as recommending the integration of PCR-specific tags in the electronic health record system to streamline future audits.
Conclusion
Conducting a PCR audit is a high-impact, relatively low-barrier project ideal for ophthalmology trainees and/or applicants. It not only supports local service improvement but also contributes to a broader national effort in surgical quality assurance. By aligning your local audit with the National Ophthalmology Database’s goals, you help reinforce a culture of accountability and continuous improvement in cataract surgery outcomes.
References
1 – The Cataract National Dataset Electronic Multi-centre Audit of 55,567 operations: variation in posterior capsule rupture rates between surgeons, Eye (Lond). 2009 Aug;23(8):1610-6
2 – Donachie PHJ, Bunchan JC, ‘The Seventh Prospective Report of the National Ophthalmology Database Audit National Cataract Audit’, National Opthalmol Database Audit, 2024.