Abstract
Purpose :
To determine the most common complications observed in resident-performed phacoemulsification, as well as the management and visual outcomes, during a 7-year time period.
Methods :
We conducted a retrospective, observational study by examining the electronic medical records of 733 patients that had a reported complication during phacoemulsification cataract surgery performed by ophthalmology residents and Anterior Segment fellows under the supervision of attending physicians, operated between 2010 to 2016 in our hospital “Instituto de Oftalmología Conde de Valenciana” in Mexico City. We included 474 records that had complete and detailed information about the type of complication, the follow-up, management and visual outcomes. We excluded patients with uncomplicated phacoemulsification cataract surgery, patients with extraocular extraction and other surgical techniques used for cataract extraction.
Results :
The mean age at the moment of surgery was 69.4 ± 10.8 years old, 202 males and 272 females, mean pre-surgical visual acuity of 1.48 LogMAR and 3 months post-surgical visual acuity of 0.36 LogMAR (p=0.0001). The most common complication identified was a posterior capsule rupture in 51.1%, zonular dialysis in 13.9%, rexis tear with 13.3%, Descemet detachment in 7.8%, poorly constructed wound incision with 2.7%, and retrobulbar hemorrhage in 2.5% of the cases. 78.5% of the patients with posterior capsular rupture had the intraocular lens placed at the sulcus and 38.4% of this needed anterior vitrectomy, posterior vitrectomy due to a luxated lens fragment to the vitreous cavity was performed in 6.6%, the rest ha the IOL placed inside the capsular bag and no vitrectomy was needed.
Conclusions :
The universe of patients operated during this 7 year period oscillates around 35,000 in the Anterior Segment department of our hospital, with 733 complications reported. This generates an incidence of complications in 2.1% of the surgeries. The most common was the posterior capsular rupture in 51.1%. This complication could be managed during the same procedure in almost all cases and only needed an additional surgery in 6.6% (posterior vitrectomy to eliminate lens fragments from the vitreous cavity). The posterior capsular rupture rate reported in the literature is around 1-3%, our study presents similar findings even in residents in training.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.