Grading the Surgical Difficulty of Cataract Phacoemulsification

Abstract

To propose a new grading system to preoperatively evaluate the difficulty of phacoemulsification surgery according to the anatomic condition of a patient's eye. In this prospective case series, a grading system covering the entire cataract spectrum was developed and field-tested in 400 consecutive patients undergoing phacoemulsification. For each eye, nine anatomic parameters were evaluated and a level of severity was assigned. The system identifies five levels of surgical difficulty based on the combined degree of severity of each parameter considered. Preoperative score and intraoperative difficulty closely corresponded in the first 400 test cases. Analysis using the Fleiss-Cohen kappa coefficient showed substantial agreement between preoperative and intraoperative scores (k value = 0.76; 95% confidence interval = 0.71 to 0.81). A grading system of the preoperative difficulties of each phacoemulsification procedure is provided. This system is easy to complete and interpret and can be transmitted to the surgeon, patient, and anyone who may subsequently examine the case.