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Danielle Trief, Paul A. Legutko, Mary K. Daly; Laterality as a Risk Factor for Intraoperative Complications During Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6689.
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To review the frequency and type of intraoperative complications during cataract surgery in an academic teaching institution and determine whether operating on the left vs. the right eye is a risk factor for intraoperative complications.
All cataract surgery performed during the academic year of 7/1/10 - 6/30/11 at the Veterans Affairs Boston Healthcare System were reviewed. A total of 695 cataract surgeries were performed and 686 were analyzed, excluding only those surgeries with a planned joint vitreoretinal procedure. Data were collected from a review of patients' electronic medical records, including the intraoperative reports. Complications were classified as either major (vitreous loss, capsular instability precluding placement of an intraocular lens in the bag or resulting in retained lens fragments, malpositioned lens requiring repeat surgery), or minor complications (capsular tears or zonular dehiscence without compromise of the capsular bag and without vitreous presentation, peripheral descemet's tear, iris prolapse resulting in iridotomy or iris damage, retained lens without capsular instability and without return to surgery for removal). A two tailed t test was used to determine whether complication rates differed significantly between left and right eyes, and whether these differences held for both major and minor complications.
Of the 686 surgeries analyzed, 340 were on left eyes and 346 were on right eyes. There were 84 complications. The rate of complications on the left eye (N=54) was higher than the right eye (N=30) and was statistically significant (p=0.004). Of the 84 total complications, 57% (N=48) were classified as major (7% of the 686 surgeries). There was a higher rate of minor complications (p= 0.035) and a trend towards significance for major complications (p= 0.063) on the left eye compared to the right. The most frequent complications observed were anterior capsular tears without vitreous loss (N=24) and posterior capsular tears with vitreous loss (N=25). Vitreous loss occurred in 3.94% of surgeries.
In this one year review of cataract surgeries performed in an academic setting, where third year residents are primary surgeons on the majority of cases, there was a greater rate of intraoperative complications on the left eye compared to the right. The statistical difference seen here may reflect greater difficulty in positioning and operative technique on left eye surgeries as compared to right. Laterality may be a risk factor for complications during cataract surgery and should be considered especially when training residents.
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