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Daniela Pulido, Arturo Ramirez-Miranda, Marisol Garzon, Eduardo Chávez-Mondragón; Incidence of Intraoperative Complications in Cataract Surgery Performed by Residents. The Mexican Experience. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2798.
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To determine the incidence of complications in resident-performed cataract surgery, its management, and postoperative visual acuity. We compare our results with the previously published data.
We prospectively analyzed the incidence of complications in cataract surgery, either phacoemulsification or manual extracapsular cataract extraction, performed by residents in an university based ophthalmologic Hospital in Mexico City between March 1, 2010 and October 28, 2010. Every complicated patient was reported, its management, and the visual acuity on day 1, week one, and every visit till October 28 2010.
1867 cataract surgeries were included into the study. 106 cases (0.05%) had complications reported, in which 80% (n=85) were phacoemulsification and 20% (n=21) were manual extracapsular extraction. Posterior capsular rupture (PCR) was the most common complication in 52% (n=55) of the cases, followed by zonular dialysis in 18% (n=19), capsulorhexis tear 13.2 % (n=14), Descemet membrane detachment 5.7% (n=6), expulsive choroidal hemorrhage 1.9% (n=2), and acute endophthalmitis 1.9% (n=2). In the PCR and zonular dialysis groups, 60% and 58% of the cases required anterior vitrectomy respectively, while 3.6% required pars plana posterior vitrectomy. In this complicated cases 16% required a second intervention, either a wound revision or Nd:Yag laser vitreolysis. The intraocular lens (IOL) position was also assessed, being the ciliary sulcus the most common IOL position 74.5%, the capsular bag 16.3%, anterior chamber and iris-sutured 1% respectively, while 7.1% remained aphakic. The mean uncorrected visual acuity at postoperative day 1 was .04 logMAR (SD 0.91, range 0.18 to LP) and 0.60 logMAR (SD 0.89, range 0 to NLP) at the last visited registered.
The rate of surgical complications for residents learning cataract surgery in a supervised manner is acceptably low. Since cataract surgery is the most common surgical procedure in ophthalmology training programs we should know the rate of those in the facility where the residents are performing the surgeries in order to be aware of them and promptly resolve them in the adecuate manner. To the best of our knowledge in the peer- reviewed literature the incidence of complications after cataract surgery ranges between 2% and 14.7%, but most of the reports are phacoemulsification only.
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