A large European registry analysis examined more than 2.8 million cataract surgeries to identify factors associated with posterior capsule rupture (PCR), one of the most important intraoperative complications in cataract surgery. PCR occurred in about 1.1% of cases, with the rate decreasing over the study period. Several preoperative characteristics were associated with substantially higher risk, including corneal opacity, diabetic retinopathy, poor preoperative visual acuity, and white cataract. These findings reinforce a simple but important principle: PCR prevention begins before the first incision. Careful preoperative identification of dense or intumescent cataracts, corneal visibility limitations, retinal comorbidity, and reduced baseline vision can help surgeons anticipate difficult visualization and altered intraoperative anatomy. The data also support structured risk stratification and appropriate allocation of challenging cases to surgeons with suitable experience and equipment. For teaching and surgical planning, the study is particularly useful because it moves PCR risk discussion beyond isolated technical errors and toward patient-level predictors. In practice, identifying high-risk eyes can influence consent, operating-room preparation, availability of capsular support devices, and the threshold for modifying the surgical plan when zonular or capsular instability becomes apparent.