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J. S. Bryant, P. Lin, B. H. Jeng; Visual Outcomes in Eyes Undergoing Resident Performed Phacoemulsification Cataract Surgery Complicated by Posterior Capsule Rupture. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5442.
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Although the complication rate for resident-performed cataract surgeries range from 2.0-14.7%, it is thought that good visual outcomes can still be achieved in these eyes. The purpose of this study is to determine which intraoperative factors may have an effect on visual outcomes in resident-performed phacoemulsification cataract (phaco) surgeries complicated by posterior capsule rupture.
This is a retrospective cohort study of all of the phaco surgeries performed by residents at the San Francisco General Hospital between July 1, 2007 and September 30, 2009. Cases were identified by reviewing operative notes and clinic notes of patients that developed posterior capsular rupture during phaco surgery. Eyes were excluded if they had less than one month of post-operative follow-up. The intraoperative techniques used, as well as final best corrected visual acuity (BCVA) were recorded. BCVA was also compared to historical visual outcomes from our institution of resident performed phaco surgeries where 5% (13/267) of uncomplicated resident performed cataract surgeries had a BCVA < 20/40.
During the study period, 526 resident phaco surgeries were performed, with 47 cases (8.94%) complicated by posterior capsule rupture. Forty-five of the 47 eyes had at least one month of post-operative follow-up. Twenty-five of these 45 eyes (55.6%) had sulcus intraocular lens (SIOL) implantation. Of these 25 eyes, 17 (68.0%) had a BCVA < 20/40. Eleven out of the 45 eyes (24.4%) had posterior chamber intraocular lens (PCIOL) implantation in the bag with 5 of the 11 (45.5%) having BCVA < 20/40. Six of the 45 eyes (13.3%) had anterior chamber intraocular lens (ACIOL) implantation, with 5 of these 6 eyes (83.3%) having a visual acuity < 20/40. The remaining 3 out of 45 eyes (6.7%) were left aphakic, with 2 of the 3 eyes (66.7%) having a BCVA < 20/40. Compared to our historical controls, the odds ratio of having a BCVA < 20/40 in a complicated phaco surgery was 41.5 when SIOL implantation was performed (95% CI 15.4-112.1; p<0.001); it was 16.3 with PCIOL implantation (95% CI 4.7-57.7; p<0.001); it was 97.7 with ACIOL implantation (95% CI 13.7-667.7; p<0.001); and it was 39.1 when the eye was left aphakic (95% CI 4.7-315.5; p=0.008).
In resident-performed phaco surgeries complicated by posterior capsule rupture, good outcomes are achievable, but there is a significantly higher rate of final visual acuity being <20/40.
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