Visual Outcomes of Patients with Posterior Capsule Complications In Early Resident Cataract Surgery

Abstract

Purpose : To report the visual outcomes and clinical characteristics of patients with posterior capsular complications that occur in cataract surgery performed by novice resident surgeons.

Methods : In this retrospective analysis, we reviewed the first 50 cataract surgeries performed by 10 residents between 2014-2018 at the Veterans Affairs Medical Center in Hampton, Virginia. Patients identified as having a posterior capsule (PC) complication were included in the study. Data recorded included intraocular lens (IOL) placement location, need for additional surgery, incidence of cystoid macular edema (CME), and final visual outcome.

Results : Of the 500 cases reviewed, 33 (6.6%) had PC complications. In 5 patients (15.2%) there was no vitreous loss and a single piece IOL was placed in the capsular bag. In the remaining 28 cases (84.8%), a three piece IOL was placed in the sulcus. 9 patients (27.2%) had retained lens material and were referred for retinal evaluation. 8 of these patients (88.9%) required pars plana vitrectomy for removal of nuclear material. One patient with retained lens fragments was observed. 3 patients were lost to follow up soon after cataract surgery and one patient developed endophthalmitis. These four patients were excluded from further analysis. In the remaining 29 patients, 6 patients (20.7%) developed CME. In patients with retained lens material, 2 out of 9 (22.2%) developed CME. Overall 27/30 (90%) of patients achieved 20/30 or better final visual acuity. In the 3 patients with vision worse than 20/30, one patient had retained lens fragments and CME with a final vision of 20/60. Another had CME only with a final vision of 20/40 and the final patient had vision of 20/40 with no identified co-morbidities.

Conclusions : PC tears occur more commonly early in resident training. We report an average rate of 6.6% in the first 50 cases of resident cataract surgery that is consistent with similar studies. We believe that the successful placement of a posterior chamber lens along with appropriate management of vitreous loss, retained nuclear material and CME underlie the overall excellent visual results that we observed. In most patients in this study, the development of CME or need for additional surgery to remove lens fragments did not adversely affect the final visual outcome; however, CME was an important cause of reduced final visual acuity in this study group.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.