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M. Touati, N. Duchâteau, D. Monnet, E. Delair, A. P. Brézin; From Glitches to Major Complications During Cataract Surgery: A Study of 4808 Cases. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5565.
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© ARVO (1962-2015); The Authors (2016-present)
The rate of major incidents occurring during cataract surgery such as posterior capsular ruptures has been assessed in several studies. However, a comprehensive analysis of all incidents, from minor glitches to major adverse events, is lacking. Our objective was to assess the frequency and characteristics of every incident and adverse event occurring during cataract surgery by phacoemulsification.
The study was set in the department of Ophthalmology of a University Hospital and all events which occurred from January 2005 to October 2008 were prospectively recorded. A standardized severity scale was defined and events were graded as 0-minor (e.g. malfunctioning phacoemulsifier detected prior to the introduction of the handpiece into the eye, damaged IOL detected before injection), 1-minimal (e.g. malfunctioning phacoemulsifier during the surgery, peripheral mark on the IOL detected after implantation), 2-moderate (e.g. localized hole in the posterior capsule without vitreous loss, implantation of a damaged IOL requiring an exchange during the procedure), 3-intermediate (e.g. posterior capsular rupture with vitreous loss and placement of an IOL in the sulcus), 4-severe (e.g. posterior capsular rupture without placement of an IOL), 5-major (e.g. dislocated nucleus). The rate of incidents was analyzed in relation to the surgeons' experience.
4808 procedures were performed by 14 surgeons. 322 (6.83%) incidents were recorded. They were distributed as grade 0 : 149 events (3.12%), grade 1 : 63 events (1.34 %), grade 2 : 47 events (1.04%), grade 3 : 46 events (0.99%), grade 4 : 10 events (0.21%) and grade 5 : 6 events (0.14%). The three most frequent incidents were marks on the IOL : 62 events (1.31%), localized posterior capsular holes : 43 events (0.91%), and phacoemulsifier dysfunction prior to the introduction of the handpiece into the eye : 40 events (0.80%). A lesser rate of adverse events was observed during procedures performed by experienced surgeons.
Glitches were common during cataract surgery. Although these minor events did not affect the outcome of surgery, a thorough analysis of their causes may help to optimize the reliability of surgical procedures.
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