To the Editor:

We read with great interest the article by Narayan et al. [1], which provides a timely and large-scale analysis of when posterior capsular rupture (PCR) occurs during cataract surgery. The finding that PCR most frequently occurs during phacoemulsification (60%), followed by irrigation-aspiration (IA; 24%), offers an important update to surgical risk awareness.

A key insight is the reduced incidence of IA-associated PCR compared to historical studies, which the authors rightly attribute to improved bimanual techniques and silicone-tipped instruments. Furthermore, the strong link between anterior capsular (AC) tears and early PCR (80% during hydrodissection or phacoemulsification) underscores how an unstable capsulorhexis can precipitate posterior complications. This relationship logically influences IOL placement strategy, as seen in the very low rate of in-the-bag implantation (4.5%) when an AC tear is present.

However, the study’s broad classification of surgical stages represents a limitation. Grouping all phacoemulsification sub-steps—such as grooving, cracking, and quadrant removal—obscures more precise, high-risk moments. A finer-grained analysis could reveal whether PCR is more common during sculpting, fragment removal, or the evacuation of the final nucleus piece.

Such detail would help elucidate the underlying mechanisms: for instance, whether PCR in phacoemulsification arises primarily from posterior capsule contact, excessive zonular stress, or extension of an AC tear. Correlating these sub-stages with preoperative factors like lens density or surgeon experience might further stratify risk.

In conclusion, this study valuably recalibrates our understanding of PCR timing. Future work dissecting phacoemulsification into distinct technical phases could enhance procedural safety by identifying specific, high-risk surgical manoeuvres.