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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-09-2012 | Cataract

Complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery

Authors: Andrea Briszi, Philipp Prahs, Jost Hillenkamp, Horst Helbig, Wolfgang Herrmann

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 9/2012

Abstract

Background/Aim

To determine the complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery at a tertiary care center during the first 100 surgeries.

Methods

Retrospective chart review of the first 100 performed phacoemulsification cases of six consecutive residents. Posterior capsule tear, vitreous loss, and dislocation of lenticular fragments into the vitreous were defined as intraoperative complications. Patient characteristics considered risk factors for surgery were identified and correlated with the occurrence of intraoperative complications.

Results

Complications occurred in 23 of 600 operations (3.8 %). Surgery was complicated by posterior capsular tear in 23 eyes (3.8 %) with vitreous loss in 17 eyes (2.8 %) and loss of lenticular fragments into the vitreous in seven eyes (1.2 %). Eyes with dense nuclear sclerosis (p = 0.002) and white cataracts (p = 0.019) were associated with a statistically significantly greater incidence of posterior capsular tears and vitreous loss (p = 0.007 and p = 0.027 respectively). An intraocular lens was implanted in 591 eyes as intended.

Conclusions

Residents achieve an acceptable complication rate during their initial 100 phacoemulsification cases.

Resnikoff S, Pascolini D, Etya’ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP (2004) Global data on visual impairment in the year 2002. Bull World Health Organ 82:844–851PubMed

Tabin G, Chen M, Espandar L (2008) Cataract surgery for the developing world. Curr Opin Ophthalmol 19:55–59PubMedCrossRef

Rutar T, Porco TC, Naseri A (2009) Risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Ophthalmology 116(3):431–436PubMedCrossRef

Minassian DC, Rosen P, Dart JKG, Reidy A, Desai P, Sidhu M (2001) Extracapsular cataract extraction compared with small incision surgery by phacoemulsification: a randomised trial. Br J Ophthalmol 85:822–829PubMedCrossRef

Johnston RL, Taylor H, Smith R, Sparrow JM (2009) The Cataract National Dataset Electronic Multicentre Audit of 55,567 Operations: variation in posterior capsule rupture rates between surgeons. Eye 24:888–893PubMedCrossRef

Ang GS, Whyte IF (2006) Effect and outcomes of posterior capsule rupture in a district general hospital setting. J Cataract Refract Surg 32:623–627PubMedCrossRef

Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Asaria RH, Galloway P, Sparrow JM (2009) The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye 23(1):31–37PubMedCrossRef

Ionides A, Minassian D, Tuft S (2001) Visual outcome following posterior capsule rupture during cataract surgery. Br J Ophthalmol 85(2):222–224PubMedCrossRef

Chylack LT Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, Friend J, McCarthy D, Wu SY (1993) The lens opacities classification system III. For the longitudinal study of cataract study group. Arch Ophthalmol 111(6):831–836PubMedCrossRef

10.

Bhagat N, Nissirios N, Potdevin L, Chung J, Lama P, Zarbin MA, Fechtner R, Guo S, Chu D, Langer P (2007) Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School. Br J Ophthalmol 91(10):1315–1317PubMedCrossRef

11.

Corey RP, Olson RJ (1998) Surgical outcomes of cataract extractions performed by residents using phacoemulsification. J Cataract Refract Surg 24(1):66–72PubMed

12.

Tarbet KJ, Mamalis N, Theurer J, Jones BD, Olson RJ (1995) Complications and results of phacoemulsification performed by residents. J Cataract Refract Surg 21(6):661–665PubMed

13.

Prasad S (1998) Phacoemulsification learning curve: experience of two junior trainee ophthalmologists. J Cataract Refract Surg 24(1):73–77PubMed

14.

Claoué C, Steele A (1993) Visual prognosis following accidental vitreous loss during cataract surgery. Eye 7(6):735–739PubMedCrossRef

15.

Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK (2007) The resident surgeon phacoemulsification learning curve. Arch Ophthalmol 125(9):1215–1219PubMedCrossRef

16.

Albanis CV, Dwyer MA, Ernest JT (1998) Outcomes of extracapsular cataract extraction and phacoemulsification performed in a University Training Program. Ophthalmic Surg Lasers 29(8):643–648PubMed

17.

Dooley IJ, O’Brien PD (2006) Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees. J Cataract Refract Surg 32(4):604–608PubMedCrossRef

18.

Pedersen OØ (1990) Phacoemulsification and intraocular lens implantation in patients with cataract. Experiences of a beginning 'phacoemulsification surgeon'. Acta Ophthalmol 68(1):59–64

19.

Badoza DA, Jure T, Zunino LA, Argento CJ (1999) State-of-the-art phacoemulsification performed by residents in Buenos Aires, Argentina. J Cataract Refract Surg 25(12):1651–1655PubMedCrossRef

20.

Allinson RW, Metrikin DC, Fante RG (1992) Incidence of vitreous loss among third-year residents performing phacoemulsification. Ophthalmology 99(5):726–730PubMed

21.

Quillen DA, Phipps SJ (2003) Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience. Am J Ophthalmol 135(5):732–733PubMedCrossRef

22.

Thomas R, Naveen S, Jacob A, Braganza A (1997) Visual outcome and complications of residents learning phacoemulsification. Indian J Ophthalmol 45(4):215–219PubMed

23.

Tayanithi P, Pungpapong K, Siramput P (2005) Vitreous loss during phacoemulsification learning curve performed by third-year residents. J Med Assoc Thai 88(9):89–93

24.

Noecker RJ, Allinson RW, Snyder RW (1994) Resident phacoemulsification experience using the in situ nuclear fracture technique. Ophthalmic Surg 25(4):216–221PubMed

25.

Lee J-S, Hou C-H, Yang M-L, Kuo JZ-C, Lin K-K (2009) A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates. Eye 23(3):683–687PubMedCrossRef

26.

Biró Z, Kovacs B (2002) Results of cataract surgery in previously vitrectomized eyes. J Cataract Refract Surg 28(6):1003–1006PubMedCrossRef

27.

Pinter SM, Sugar A (1999) Phacoemulsification in eyes with past pars plana vitrectomy: case-control study. J Cataract Refract Surg 25(4):556–561PubMedCrossRef

28.

Zaheer I, Taylor SRJ, Pearson RV (2007) Phacoemulsification in vitrectomized eyes under topical anesthesia. Eur J Ophthalmol 17(3):336–340PubMed

29.

Misra A, Burton RL (2005) Incidence of intraoperative complications during phacoemulsification in vitrectomized and nonvitrectomized eyes: prospective study. J Cataract Refract Surg 31(5):1011–1014PubMedCrossRef

30.

Martin KRG, Burton RL (2000) The phacoemulsification learning curve: per-operative complications in the first 3,000 cases of an experienced surgeon. Eye 14(2):190–195PubMedCrossRef

Title: Complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery
Authors: Andrea Briszi
Philipp Prahs
Jost Hillenkamp
Horst Helbig
Wolfgang Herrmann
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 9/2012
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-012-2003-y

At a glance: The STEP trials

Springer Medicine

Complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery

Abstract

Background/Aim

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background/Aim

Methods

Results

Conclusions

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