1 Year Study Results Evaluating Pupil Size and Complications in Phacoemulsification Cataract Surgery During Residency Training

Abstract

Abstract: : Purpose: The goal of this study is to quantitatively evaluate the relationship between pupil size and incidence of surgical complications in phacoemulsification cataract surgery during residency training. There is limited data in the literature regarding pupillary measurement as it relates to specific rates of surgical complications in phacoemulsification. It is the ultimate goal of this study to help guide beginning cataract surgeons when pupillary size may constitute a significant risk factor and perhaps require surgical technique alterations such as mechanical means of enlarging pupillary size. Methods: This study is a prospective chart review of patients undergoing elective cataract surgery at the West Haven Connecticut Veteran's Hospital from September, 2001 to September, 2002. A total of 137 cases between 4 PGY-4 surgeons: LD; n=31 and EC; n=33, CR; n=16, GJ; n=57 were included. Pupil diameter was measured immediately prior to surgery using the Colvard Pupillometer device(OASIS; Glendora, CA). Phacoemulsification cataract surgery was carried out in a divide and conquer technique. Charts were then reviewed and pupil size, surgical outcome, and postoperative course were recorded. Data recorded included patient sex, age, medical history, ocular history, intraocular lens used, and surgical technique. Complications included posterior capsule tear, vitreous loss, post-op intraocular pressure spikes, endophthalmitis, dropped or retained cortex, inadequate capsulorhexis requiring sulcus lens placement, and conversion to large incision extracapsular cataract surgery. Results: : One year results based on 137 cases show no significant difference in mean pupil size between cases with and without complications: 6.62mm in the non-complication group and 6.79mm in the complication group with a p-value of 0.195 by t-test. The mean pupil size for posterior capsule tear was 6.99mm compared to 6.63mm for all others with a p-value of .082 by t-test. Conclusions: Current results demonstrate no significant difference in complication rate based on pupil size as measured by the Pupillometer for beginning surgeons. While previous studies have shown increasing rates of complications in cataract surgery with decreasing pupil size, other factors may be more important in determining risk of complications in the hands of beginning surgeons. This study shows a trend towards more complications with larger pupils. This may reflect the beginning surgeon’s decreased vigilance when operating with larger pupils. Further study and evaluation is warranted.

Keywords: treatment outcomes of cataract surgery • cataract • pupil