An observational study to compare Muhtaseb's and Habib's scoring systems in patients undergoing phacoemulsification to predict risk in cataract at a tertiary centre in West Bengal


  • Jagan Nandan Prasad Singh Department of Ophthalmology and JNM Hospital, Kalyani, West Bengal, India
  • Atanu Biswas Department of Ophthalmology and JNM Hospital, Kalyani, West Bengal, India



Snellen’s chart, Posterior capsular rupture, Posterior polar cataract


Background: Cataract is derived from the Latin ‘cataracta’, meaning ‘waterfall’ as rapidly running water turns white, so term may have been used metaphorically to describe similar appearance of mature ocular opacities.1

Methods: This observational study with prospective study design has been conducted in the college of medicine and JNM hospital, department of ophthalmology, COMJNMH, Kalyani-741235, Nadia District, West Bengal which catering mostly the rural and also urban population. The study was done spread over a period of 18 months starting from July 2018 to December 2019, i.e., 1 year for research and 6 months for analysis. It included all patients, irrespective of age, undergoing Phacoemulsification surgery for cataract admitted in our hospital fulfilling the laid criteria for the study.

Results: The study consisted of total 147 cases in these 14 (9.52%) cases complicated with PCR, 10 (6.80%) striate keratopathy and 4 (2.72%) cases complicated with both PCR and striate keratopathy. Though sample size derived was 126 cases, 147 cases were studied during the research period of 1 year. Out of 10.89% cases of miscellaneous risk (ex: poor position of the eye/patient) risk factor, posterior capsule rupture (12.5%), striate keratopathy (12.5%), cases having both complication (00.0%) and total complicated cases (25%) which is 1.36%, 1.36%, 0% and 2.72% of total cases respectively. Out of 8.84% cases of unable to lie flat risk factor, posterior capsule rupture (15.38%), striate keratopathy (7.69%), and total complicated cases (23.07%) which is 1.36%, 0.68% and 2.04% of total cases respectively.

Conclusions: The current study tries to validate two scoring systems to predict complications during phacoemulsification surgerylike risk of posterior capsule rupture and striate keratopathy and to predict the potential difficulty of a case.


WHO Team. The Global Burden of Disease: 2004 Update. Geneva, Switzerland: World Health Organization. 2008;35-42. Available at: Accessed on 3 November 2022.

Goes, Joseph F. The Eye in The History. JP Medical Ltd. 2013;367-71.

Bonnie H. Extracapsular Cataract Extraction. Essentials of Cataract Surg. 2007;187-92.

Leanming DY. Practice Styles and Preferences of ASCRS Members-1996 Survey. J Cataract Refract Surg. 1997;23:527-35.

Enubi K, Sam YY, Young JS. Studies On Cornea and Lens, Springer. 2014;4-10.

Pascal H. Essential Principles of Phacoemulsification. JP Medical Ltd. 2013;21-32.

Gault J, Vander J. Ophthalmology Secrets in Colour. Elsevier Health Sciences. 2015;221-31.

Ng DT. Intraoperative Complications of 1000 Phacoemulcification Procedure: A Prospective Study. J Cataract Refract Surg. 1998;24:1390-95.

Ang GS, Whyte IF. Effect and Outcome of Posterior Capsule Rupture in District General Hospital Setting. J Cataract Refract Surg. 2006;32:623-7.

Smith JH, Seiff Sr. Outcome of Cataract Surgery by Resident ata Public Country Hospital. Am J Ophthalmol. 1997;123:448-54.

Muhtaseb M, Kalhoro A, Lonides A. A System for Preoperative Stratification of Cataract Patient According to Risk of Intra Operative Complication: A Prospective Analysis of 1441 Cases. Br J Ophthalmol. 2004;88:1242-6.

Habib MS, Bunce CY, Fraser SG. The Role of Case Mix in The Relation of Volume and Outcome in Phacoemulsification. Br J Ophthalmol. 2005;89(9):1143-6.

Blomquist PH, Sargent JW, Winslow HH. Validation of Najjar-Awad Cataract Surgery Risk Score for Resident Phacoemulsification Surgery. J Cataract Refractive Surg. 2010;10:1753-7.

Tarbet KJ, Mamalis N, Theurer J, Jones BD, Oslon RJ. Complications and results of phacoemulsification performed by residents. J Cataract Refract Surg. 1995;21:661-5.

Corey RP, Olson RJ. Surgical Outcomes of Cataract Extractions Performed by Residents Using Phacoemulsification. J Cataract Refract Surg. 1998;24:66-72.

Lee JS, Hou CH, Yang ML, Kuo JZC, Lin KK. A different approach to assess resident phacoemulsification learning curve: Analysis of both completion and complication rates. Eye. 2009;23:683-7.

Rutar T, Porco TC, Naseri A. Risk Factors for Intraoperative Complications in Resident-Performed Phacoemulsification Surgery. Ophthalmology. 2009;116:431-6.

Chakbarti A. Posterior Capsular Rent Prevention and Management. Indian J Ophthalmol. 2017;65(12):1359-69.

Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM et al. The Cataract National Dataset Electronic Multicentre Audit of 55,567 Operations: Risk Stratification for Posterior Capsule Rupture and Vitreous Loss. Eye (Lond). 2009;23:31-7.

Chen M, Lamattina KC, Patarianakos T, Dwarakanathan S. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical centre: A clinical audit. Clin Ophthalmol. 2014;8:375-8.

Hashemi H, Mohsmmadpour M, Jabbarvand M, Nezamdoost Z, Ghadimi H. Incidence of and risk factors for vitreous loss in resident-performed phacoemulsification surgery. J Cataract Refract Surg. 2013;39:1377-82.

Dada T, Sharma N, Vajpayee RB, Dada VK. Conversion from phacoemulsification to extracapsular cataract extraction: Incidence, risk factor, and visual outcome. J Cataract Refract Surg. 1998;24:1521-4.

Fernandez-Buenaga R, Alio JL, Perez-Ardoy AL. Late in-the-bag intraocular lens dislocation requiring explanation: Risk factors and outcomes. Eye (Lond). 2013;27(7):795-801.

Zuberbuhler B, Seyedian M, Tuft S. Phacoemulsification in eyes with extreme axial myopia. J Cataract Refract Surg. 2009;35(2):335-40.

Fesharaki H, Peyman A, Rowshandel M, Peyman M, Alizadeh P, Akhlaghi M et al. A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length. Adv Biomed Res. 2012;1:67-73.

Haigis W. Intraocular lens calculation after refractive surgery for myopia: Haigis L formula. J Cataract Refract Surg. 2008;34(10):1658-63.

Naumann G. Exfoliation syndrome as a risk factor for vitreous loss in extracapsular cataract surgery. Acta Ophthalmol. 1988;184:S129-31.

Kuchle M, Schonherr U, Dieckmann U. Risk factors for capsular rupture and vitreous loss in extracapsular cataract extraction. Fortschr Ophthalmol. 1989;86:417-21.

Waldmann NP. Cataract Surgery in High Hyperopia Klin Monatsbl Augenheillkd. 2018;235(04):413-5.

Berler DK. Intraoperative complications during cataract surgery in the very old. Trans Am Ophthalmol Soc. 2000;98:127-30.

Chakbrati A, Singh S, Krishnadas R. Phacoemulsification in eyes with white cataract. J Cataract Refract Surg. 2000;26:1041-7.

Singh R, Vasavada A, Janaswamy G. Phacoemulsification of brunescent and black cataracts. J Cataract Refract Surg. 2001;27:1762-9.

Vasavada A, Singh R. Phacoemulsification in eyes with posterior polar cataract. J Cataract Refract Surg. 1999;25:238-45.

Osher R, Yu BCY, Koch D. Posterior polar cataracts: A predisposition to intraoperative capsular rupture. J Cataract Refract Surg. 1990;16:157-62.

Osborne SA, Adams WE, Bunce V, Fraser SG. Validation of Two Scoring Systems for the Prediction of Posterior Capsule Rupture During Phacoemulsification Surgery. Br J Ophthalmol. 2006;90:333-6.

George D Kymionis et al. Anterior Segment Optical Tomography for Demonstrating Posterior Capsular Rent in Posterior Polar Cataract. J Clin Ophtalmol. 2014;8:215-7.

Zare M. In study of Risk Factors for Posterioe Capsule Rupture and Vitreous Loss during Phacoemulsification. J Ophthalmic Vis Res. 2009;4(4):208-12.

Lumme P, Laatikainen LT. Risk factors for intraoperative and early postoperative complications in extracapsular cataract surgery. Eur J Ophthalmol. 1994;4:151-8.

Awan KJ, Humayun M. Extracapsular cataract surgery risks in patients with exfoliative syndrome. Pakistan J Ophthalmol. 1986;2:79-80.

Landa G. Manual removal of primary posterior capsular plaques using retinal end grasping forceps. Ophthalmol Ther. 2017;6(2):351-3.

Osborne SA, Severn P, Bunce CV, Fraser SG. The Use ofa Pre-Operative Scoring System for The Prediction of Phacoemulsification Case Difficulty and The Selection of Appropriate Cases to Be Performed by Trainees. BMC Ophthalmol. 2006;6:38.

Hayashi K, Hayashi H, Nakao F. Outcomes of surgery for posterior polar cataract. J Cataract Refract Surg. 2003;29:45-9.

Mullhern M, Kelly G, Barry P. Effects of posterior capsular disruption on the outcome of phacoemulsification surgery. Br J Ophthalmol. 1995;79:1133-7.

Tyson S. A system for preoperative stratification of cataract patients according to risk of complications: A prospective analysis of 1441 cases comment. Evidence Based Eye Care. 2005;6:121-3.




How to Cite

Singh, J. N. P., & Biswas, A. (2023). An observational study to compare Muhtaseb’s and Habib’s scoring systems in patients undergoing phacoemulsification to predict risk in cataract at a tertiary centre in West Bengal. International Journal of Research in Medical Sciences, 11(6), 1969–1977.



Original Research Articles