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J.B. Ciolino, J.Y. Kim, B.A. Henderson, S.L. Cremers; The Role of Anterior Chamber Depth in the Complication Rate in Cataract SurgeryPerformed by Residents . Invest. Ophthalmol. Vis. Sci. 2006;47(13):653.
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To evaluate the role of anterior chamber depth in the posterior capsular tear and vitreous loss rate in cataract extraction cases performed by residents.
All cataract extraction cases performed by residents at the Massachusetts Eye and Ear Infirmary’s Comprehensive Ophthalmology service from January 2003 through June 2003 were prospectively examined. ACD was measured pre–operatively by ultrasound A–scan in 176 patients. No patients were excluded from the study. The cases were separated into three groups based on the mean ACD + 1 Standard Deviation: <2.93 mm, 2.93 to 3.73 mm, >3.73 mm. Posterior capsule tear (PCT) and vitreous loss (VL) were the intra–operative complications reviewed. Multivariate logistic regression analysis was performed and included the following variables: age, gender, axial length, diabetes mellitus, glaucoma, age related macular degeneration, surgical semester, and pseudoexfoliation (PXF) syndrome.
176 cases were analyzed. The rate of PCT and VL was not statistically significant between the three groups. In the group with an ACD less than 2.93 mm the PCT and VL rates were both 10.00 %. For the group with the deepest ACD, greater than 3.73 mm, the PCT rate was 7.41% and the VL rate was 3.70%. Finally for the group with ACD between 2.93 and 3.73 mm the PCT rate was 10.07% and the VL rate was 6.97%. Using univariate logistic regression analysis, the PCT rates were found not to be statistically significant (p=.76, OR 1.25). Multivariate logistic regression analysis found that PXF was the only predictive factor for vitreous loss.
Our data indicates that the anterior chamber depth does not appear to be an independent factor in the intra–operative complication rate of cataract extraction performed by residents. This finding is important and surprising since it may seem that a smaller anterior chamber depth would constrict the operating space and thus create a more difficult surgical environment for a resident learning cataract surgery. However, our data demonstrated that a smaller anterior chamber depth did not increase intra–operative complication rates for surgeons learning cataract surgery. Further investigation may demonstrate other factors which may influence resident complication rates in cataract surgery.
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