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A. B. Sheth, B. J. Markovitz, D. S. Rho, S. M. Soll; Visual Outcomes and Incidence of Complications in Resident Performed Extracapsular Cataract Extraction versus Phacoemulsification in Advanced Cataracts. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6114.
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In recent years, phacoemulsification (PE) has become the primary cataract procedure for all degrees of cataracts. Traditionally, extracapsular cataract extraction (ECCE) has often been used instead of PE in resident surgeries for very advanced cataracts and cases with other risk factors such as pseudoexfoliation, miotic pupils or posterior synechiae. We examined the visual outcomes and complication rates of surgeries on advanced cataracts using both techniques performed by residents at Cooper University Hospital.
A retrospective review was performed on 589 consecutive cataract surgeries performed by second and third year Wills Eye residents from January 2002 to December 2006. We defined advanced cataracts as those having best corrected preoperative visual acuity of count fingers or worse. Of the 589 surgeries, 107 where found to have advanced cataracts. Of the 107 advanced cataracts, 24 had ECCE performed and 83 had PE performed. Seventeen additional cases with preoperative VA better than CF but other complicating factors underwent ECCE. Details of intraoperative complications including posterior capsule tears, vitreous loss, zonular dehiscence, dropped and retained lens material were compared. Best corrected post-op visual acuity (BCVA) and time to best corrected acuity were also compared.
Complications occurred in 19.5% of ECCE procedures and 13.3% of PE procedures. Of the cases analyzed, posterior capsular rent occurred in 14.6% versus 10.8%, vitreous loss occurred in 17.1% vs 13.3%, zonular dehiscence occurred in 2.4% of both ECCE and PE, dropped/retained lens material occurred in 4.9% vs 3.6%, of ECCE versus PE cases respectively. BCVA for ECCE cases was 20/40 or better in 26.3% of cases in an average of 5.9 weeks, 20/50-20/80 in 39.5% of cases in 5.8 weeks, 20/100-20/200 in 18.4% of cases in 1.5 weeks and final BCVA was 20/400 or worse in 13.2% of ECCE cases. BCVA for PE cases was 20/40 or better in 35.4 % of cases in 6.8 weeks, 20/50-20/80 in 26.6% of cases in 7.7 weeks. 20/100-20/200 in 25.3% of cases in 3.7 weeks and final BCVA was 20/400 or worse in 12.7% of PE cases.
Our study demonstrated that the visual outcome and complication rate for PE compared favorably to ECCE for advanced cataracts performed by resident surgeons. A decision to perform ECCE instead of PE to lessen the chance of complications and speed visual recovery in surgery by residents may be unfounded.
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