Intraoperative Complications Of Cataract Surgery Research Articles

Association Between Intraoperative Cataract Surgical Complications and Mortality

ABSTRACT Purpose To evaluate the association between intraoperative complications of cataract surgery and postoperative mortality. Methods A retrospective review of patients who underwent cataract surgery at our institution from 2014 to 2020 was conducted. Intraoperative complications included choroidal hemorrhage, posterior capsule rupture, vitreous loss, retained lens, and/or severe zonular dialysis in either eye. All-cause mortality statistics were obtained through a collaborative agreement with the Colorado Department of Public Health and Environment. Hazard ratios (HRs) from Cox proportional hazard models were used to estimate survival following cataract surgery. Results Among 8,054 patients, the mean follow-up time was 4.4 (SD = 2.3) years and the mortality rate was 15% (n = 1,175). The overall complication rate was 2.2% (n = 181), and the rate of retained lens was 0.7% (n = 58). In univariate analysis, retained lens (HR: 1.86, 95% CI: 1.08–3.21, p = 0.026), severe zonular dialysis (HR: 2.00, 95% CI: 1.29–3.12, p = 0.002), and any intraoperative complication (HR: 1.51, 95% CI: 1.09–2.11, p = 0.015) were associated with higher hazard of mortality. When adjusted for demographic factors, comorbid medical conditions, and pre-operative visual acuity, intraoperative complications were not associated with mortality. Conclusion Intraoperative cataract surgery complications were associated with mortality in univariate analysis. However, this association was not significant in the multivariable analysis as it is confounded by other factors such as pre-operative visual acuity.

Intraoperative Complications in Cataract Surgery

Cataract surgery is frequently and successfully performed in the developed world. The indications for the operation have shifted on one hand towards healthier patients seeking freedom from glasses and on the other hand towards more complex cases. How should the patient be informed? What complications can occur intraoperatively, and what treatment options are available for these complications?This article offers a focus on conditions such as zonulopathy and pseudoexfoliation that can pose challenges to cataract surgery. It discusses the use of specialized tools such as capsular tension rings and capsular hooks and precise maneuvers to minimize stress on weakened zonules in order to ensure in-the-bag fixation of the IOL.Furthermore, the article addresses appropriate actions towards intraoperative complications such as anterior or posterior capsule ruptures and loss of nuclear fragments into the vitreous cavity.Exploring innovative advancements, this article presents the latest alternatives for intracapsular lens fixation, such as sutureless scleral fixation and emerging lens designs in cases where there is insufficient capsular support.Ultimately, the primary objective remains delivering optimal outcomes even for complex cases, and minimizing post-surgical issues. Numerous tools and techniques are available.

Racial Disparities in Cataract Surgery Timeline and Intraocular Lens Selection: A Retrospective Study.

There is a significant amount of literature focusing on racial inequities in utilization rates and intraoperative complications of cataract surgery. Unfortunately, little is known about racial disparities regarding the timeline of cataract surgery and intraocular lens (IOL) selection. This study investigated whether black patients have a different preoperative and postoperative cataract surgery timeline and IOL selection than white patients. A total of 10,235 patients (83.47% white) were retrospectively identified from a tertiary academic center who underwent cataract surgery between 2015 and 2022. Each patient's best corrected visual acuity (BCVA), slit lamp findings, and surgical timeline were recorded. IOL selection was categorized as standard or premium. Black patients had significantly worse mean ± SD preoperative logMAR BCVA than white patients (0.47 ± 0.55 vs. 0.58 ± 0.70, respectively; P = 0.0117) and were significantly less likely to receive surgery within 120days of referral (RR, 0.71 [95% confidence interval {CI}, 0.64-0.79]; P < 0.0001). White patients were 25%, 24%, and 29% less likely to follow-up than black patients at postoperative day 1, day 7, and day 30, respectively (P < 0.0001). White patients were 6.09 (95% CI, 3.49, 10.63) times more likely to receive a premium IOL compared to black patients (P < 0.0001). Black patients experienced more delays with receiving cataract surgery but are more adherent with postoperative follow-up. Black patients were far less likely to receive a premium IOL than white patients. Increased awareness of racial inequities in cataract surgery may improve the delivery of eye care to minority groups.

Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting.

In this study, we report data on intraoperative complications occurring after cataract surgery in a high-volume single-center setting using a low-energy, mobile femtosecond laser. We retrospectively reviewed the medical records of patients who underwent femtosecond laser-assisted cataract surgery (FLACS) in our hospital between August 2015 and December 2019. Among the sample of 1,806 eyes of 1,131 patients (903 left and 903 right eyes), the mean age was 75.8 years (range, 21-99 years). The overall intraoperative complication rate was 0.28% (n = 5), with three cases of anterior capsule tear (0.17%) and two cases of posterior capsule tear (0.11%). No further complications occurred. This study underlines the safety of low-energy femtosecond-assisted cataract surgery in a real-world setting with a very low rate of intraoperative complications.

Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 8, cohort analysis of the relationship between intraoperative complications of cataract surgery and axial length

ObjectivesTo describe the relationships between axial length and intraoperative complications in patients undergoing cataract surgery.DesignCohort analysis of the Royal College of Ophthalmologists’ National Ophthalmology Database (RCOphth NOD).Setting110 National Health Service...

STUDY OF INTRAOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING SMALL INCISION CATARACT SURGERY AT A TERTIARY CARE CENTRE: A DESCRIPTIVE STUDY

Background: In India,Cataract is the leading cause of avoidable blindness.2 and cataract surgery forms the major workload of most ophthalmic units in the country. An estimated 4 million people become blind because of cataract every year,3 which is added to a backlog of 10 million operable cataracts in India, whereas only 5 million cataract surgeries are performed annually in the country.4 Thus, a technique of cataract surgery that is not only safe and effective but also economical and easy for the majority of ophthalmologists. It is estimated that about 25% of poor outcomes of cataract operations performed in developing countries annually are due to surgical complications.19 Minimizing intraoperative complications of cataract surgery is an important step towards eliminating visual impairment caused by such complications. Aim &amp; Objective:1. To study intra-operative complications of manual small incision cataract surgery. 2. To study the visual outcome in patients of intra-operative complications following its management. Methods: Prospective cross sectional study, Study setting: Ophthalmology Department of tertiary care centre Study Duration: 2 years (October 2018 to December 2020).Study population: All patients with cataract requiring surgery admitted in tertiary care center Sample Size: 700 Results: Majority of study subjects belongs to age group 41 -40 years contributing 511 cases (73%) followed by age group 65 yrs and more 133 (19%),16-40 age group 35 (5%) and 15 years or less 21 (3%) respectively. males contributing 390 cases (55.71%) followed by females 310 cases (44.29%).Male: Female ratio is 1.25: 1. preoperative visual acuity in operated eye is in the range of &lt; 3 /60 - Perception to light (PLPR) in majority of subjects contributing 497 cases (71%) followed by 161 cases (23%) in between &lt; 6/ 60 - 3 /60 group, 35 cases (5%) in &lt; 6 /18 to 6 /60 group and 7 cases (1 %) in 6 /18 or better group respectively. most common intraoperative complication was posterior capsular rent contributing 19 cases (2.71%) followed by iris prolapse 14 cases (2%), premature entry 10(1.43%), Descemet's membrane stripping 10 (1.43%), intraoperative hyphaema 8 (1.14%), capsular extension in 7 cases(1%) Iridodialysis in 5 (0.71%) and zonular dialysis in 5(0.57%) respectively Conclusions: Rate of complication was higher in hypermature type of cataract .There was no statistical signicant association between age and intraoperative complications.

Development of a reliable preoperative risk stratification system for phacoemulsification.

To present a statistically validated risk classification system for intraoperative complications in cataract surgery. 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Prospective observational study. All patients underwent phacoemulsification surgery by experienced, high-volume surgeons for cases with intraoperative complications. The presence of several risk factors was statistically assessed with the help of multiple correspondence analysis to determine the more reliable rank categorization for severity and to calculate a total risk score. This study included 1572 consecutive patients. The proposed system had 3 risk groups and a no-risk group and had high statistical reliability. A comparison of this system against a previously asserted empirical system showed higher internal reliability. Previous efforts to construct a risk classification system for intraoperative complications in cataract surgery have been empirically defined and tested against practice-as-usual. The system in this study quantified risk more accurately and provided an experienced clinician with a reliable means of assessing the preoperational likelihood of intraoperative complications.

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years.

Purpose To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

Cataract Surgery and Possible Complications in Patients with Pseudoexfoliation Syndrome.

The aim of this study was to evaluate the demographic characteristics and intraoperative complications of cataract surgery in patients with pseudoexfoliation syndrome (PEX). Cases of 225 eyes (80 eyes with pseudoexfoliation and 145 eyes without pseudoexfoliation as the control group) that underwent phacoemulsification cataract surgery and IOL implantation at the Silifke State Hospital Ophthalmology Clinic between April 2011 and April 2013 were analysed retrospectively. Patients with a history of previous ocular surgeries, ocular trauma, uveitis, glaucoma or corneal pathology were not included in the study. All cataract procedures were performed by the same surgeon. Patients' age, gender, anterior segment and fundus findings in both eyes, presence of pseudoexfoliative material, pre- and postoperative day 1 intraocular pressure (IOP) and surgery notes were evaluated. There were 51 (34.7%) males and 29 (38.6%) females among the PEX cataract patients, and 98 (65.3%) male and 47 (61.8%) female controls. The incidence of pseudoexfoliation was similar in women (38.2%) and men (34.7%) (p=0.660). The mean age was 74.64±6.8 in the PEX group and 68.95±7.5 in the control group. Mean age was significantly higher in the PEX group compared to controls (p<0.001). Poor pupil dilation occurred intra-operatively in 60 (75%) of the patients with pseudoexfoliation and in 17 (11.7%) of the control patients. Frequency of poor intraoperative pupil dilation was significantly higher in the PEX group (p<0.001). Intraoperative vitreous loss occurred in 7 (8.8%) PEX patients and 5 (3.4%) controls, but this difference was statistically insignificant (p=0.090). Surgeons should be aware of the potential complications of cataract procedures in patients with PEX. Caution should be taken at every stage of the surgery to prevent these complications, and surgeons should be knowledgeable and skilful in complication management should they arise.

A cross-sectional study to compare the complications of cataract surgery with phacoemulsification in eyes with high and normal axial length

Introduction: High myopia is a risk factor for cataract formation. A relationship between myopia and higher complications in cataract surgeries has long been suggested. Materials and methods: After obtaining ethics committee clearance, this cross-sectional, case-control observational study was conducted in 100 participants of age above 18 years. They underwent cataract surgery. Participants were divided into two groups:- Group A & B - Participants with axial length between 21 and 26 mm and more than 26 mm respectively. Results and discussion: This shift of myopic individuals undergoing cataract surgery at an earlier age was found to be statistically significant. There was a statistically significant association between increasing age and PCR. Most common type of cataract in group A is cortical (30.8%) followed by nuclear (28.8%). Most common type of cataract in a group B is PSC (50%) followed by nuclear (22.9%). There was no statistical association between type of cataract and any complication. Conclusions: Intraoperative complications of cataract surgery do not increase significantly with increase in axial length. Myopic individuals are prone to develop cataracts earlier. NS and PSC type of cataracts are more common compared to cortical type of cataracts in emmetropic individuals.

Intraoperative Complications of Cataract Surgery in Tehran Province, Iran.

To determine the prevalence and types of intraoperative complications of cataract surgery and examine potential risk factors. Data were obtained from the 2011 Iranian Cataract Surgery Survey in which information about cataract surgeries throughout the nation was collected. In the Province of Tehran, 55 centers and 1 week per season per center were randomly selected for sampling. In each center, the charts of all patients who underwent cataract surgery during the selected weeks (total of 20 weeks per center) were reviewed for data extraction. The prevalence of different types of intraoperative cataract surgery complications were determined, and their relationships with age, sex, surgical method, surgeon, and hospitalization time were examined. The prevalence of intraoperative complications of cataract surgery was 4.15% (95% confidence interval, 0.94 to 7.36). The prevalence of posterior capsular rupture with vitreous loss, posterior capsular rupture without vitreous loss, retrobulbar hemorrhage, suprachoroidal effusion/hemorrhage, intraocular lens drop, and nucleus drop was 2.86, 0.69, 0.06, 0.39, 0.03, and 0.11%, respectively. The prevalence of cataract surgery complications decreased from 6.95% in 2006 to 3.07% in 2010. The results of multiple logistic regression showed that surgery by residents, nonphacoemulsification methods of surgery, and patient age less than 10 years and more than 70 years were the risk factors for complications. This study evaluated the prevalence of intraoperative complications of cataract surgery for the first time in Tehran Province. The prevalence of complications was high in this study. To achieve the goals of the Vision 2020 Initiative and improve surgical quality, it is necessary to minimize complication rates. Factors to note for decreasing complication rates include type of surgery, surgeon experience, and patient age.

Complications of Cataract Surgery in Iran: Trend from 2006 to 2010

ABSTRACTPurpose: To determine intraoperative complications of cataract surgery over the period 2006 to 2010.Methods: In this cross-sectional study, 106 of 272 cataract surgical centers in Iran were selected through multistage random cluster sampling from all provinces. In each province, the selected number of centers was proportionate to the number of cataract surgeries, and in each center, the selected number of charts was proportionate to the center’s number of cataract surgeries, from which we retrieved intraoperative complications.Results: The prevalence of intraoperative complications of cataract surgery was 5.04% (95% confidence interval, CI, 3.53–6.54%) in 2006, which decreased significantly to 3.44% (95% CI 1.84–5.04%) in 2010. The most common complication was posterior capsular rupture/vitreous loss which decreased from 4.29% (95% CI 2.93–5.66%) in 2006 to 2.81% (95% CI 1.3–4.31%) in 2010. The next most common complication was suprachoroidal hemorrhage at 0.56% (95% CI 0.25–0.87%) in 2006 and 0.46% (95% CI 0.3–0.62%) in 2010. The least common complication concerned intraocular lens (IOL)-drop. Complications were seen most with lensectomy, while phacoemulsification caused the least complications. Mean hospitalization time in uncomplicated cases was 0.59 days (95% CI 0.58–0.61 days) and in complicated cases 1.14 days (95% CI 1.07–1.20 days; p < 0.001).Conclusion: Complications of cataract surgery in Iran had a decreasing trend during 2006–2010. However, results from 2010 indicate that cataract surgical complications still need to be focused on. Hospitalization was longer for cases with complications, and further reducing this could help decrease costs of cataract surgery.

Simulated ocular surgery: cataract, glaucoma, strabismus and VR surgery

AbstractThe emergence of high fidelity virtual reality simulators has helped to raise the profile of simulation for cataract and vitreoretinal surgery. However, with the advent of the EYESi there is a misconception that all simulation needs to be high tech and expensive and is out of the reach of many training units across the globe. We will describe how innovative model eyes, can be used to teach the same skills and in many instances offer a more realistic and versatile simulation experience than virtual reality simulators and how to incorporate this form of simulation into your training programmes. With reference to cataract surgery we will demonstrate how the building blocks of phacoemulsification, such as wound construction, continuous curvilinear capsulorhexis, nucleus sculpting and IOL implantation can be practice on the model eyes. We will also demonstrate how one can simulate intraoperative complications of cataract surgery, such as posterior capsule rupture with vitreous loss, zonular dialysis and suprachoroidal haemorrhage. We will also show how these eyes can be used to simulate rectus muscle and oblique muscle surgery in a highly life‐like fashion. Commercial interest

Intraoperative floppy iris syndrome (IFIS): what complication rates can we expect?

Dear Editor, In a very interesting paper, Haridas et al. have shown that patients with intraoperative floppy iris syndrome (IFIS) receiving tamsulosin or doxazosin differ in terms of morbidity rates [1]. Among 2,785 cataract operations performed in 2,028 patients, the authors identified 52 (1.9 %) cases treated with tamsulosin and 109 (3.9 %) cases in which doxazosin was administered. They compared morbidity rates between these two groups. In our opinion, however, some aspects of this study need to be discussed. In their retrospective analysis, the authors found at least one IFIS feature in 17 out of 106 eyes (16 %) from the doxazosin group and in 25 out of 52 eyes (48 %) from the tamsulosin group. Alpha-1 antagonists, used in the symptomatic treatment of benign prostatic hyperplasia, may increase the surgical difficulties and risk of iris damage, corneal edema, posterior or anterior capsule rupture, and postoperative increase in intraocular pressure [2–4]. Nevertheless, analysis of data expressed as percentages can be misleading and provide false information on the prevalence of IFIS and expected intraoperative morbidity rate. In Table 1 of their paper, Haridas et al. presented data on the size of the pupil and status of the iris in the tamsulosin and doxazosin groups [1]. However, the prevalence of various abnormalities (large or small pupil, iris prolapse, etc.) was expressed as a percentage of IFIS cases in a given group, i.e. per 25 and 17 eyes in tamsulosin and doxazosin group, respectively. In our opinion, however, the prevalence should be rather expressed per the whole group administered a given agent, i.e. per 52 and 106 eyes of patients treated with tamsulosin and doxazosin, respectively. Only in this way can we estimate the potential risk of intraoperative complications in patients treated with α-1 antagonists. Furthermore, it should be noted that expressing seven cases of intraoperative complications in the tamsulosin group as 13.5 % (7 out of 52 eyes) suggests that such morbidity can be expected in patients subjected to cataract surgeries. This is not true, as intraoperative complications documented in the tamsulosin IFIS group (iris damage – 5 cases, anterior capsule rupture – 1 case, corneal edema – 1 case) corresponded to only 0.3 % of all 2,785 operated eyes, the average rate of cataract complications in non-IFIS patients. Takmaz analyzed a group of 858 operated eyes and identified intraoperative complications in 6 eyes of patients who were treated with tamsulosin [8]. However, he emphasized the lack of significant differences in the morbidity rates of tamsulosin-treated patients with and without IFIS (p = 0.245). According to Haridas et al., patients treated with tamsulosin differed significantly from the controls in terms of the morbidity rates (13.5 %, i.e. 7 out of 52 eyes vs. 3.3 %, i.e. 5 out of 150 eyes; p = 0.014) [1]. However, we postulate that statistical analyses are not justified in the case of such a large disproportion in group size. Furthermore, this analysis was not adjusted for surgeon’s experience and other intraoperative factors. Table 1 Studies reporting the rate of intraoperative floppy iris syndrome (IFIS) complications The exact data on the type and prevalence of intraoperative complications is missing in available literature. (Table 1) Chang et al. spoke to the intraoperative use of retractors in five cases but did not provide any data on the percentage of postoperative iris damage in patients with IFIS [2]. In turn, the report by Oshika et al. not only lacks any data on postoperative morbidity rates but does not provide any information about intraoperative strategies of performing cataract phacoemulsification in patients with IFIS [6]. Concluding: Although the use of α-1 antagonists, especially tamsulosin, can constitute a potential risk of intraoperative complications in cataract surgery, such complications occur sporadically, and therefore, the morbidity rates should be presented in a uniform manner in order to avoid their inadvertent overestimation.

Komplikationsmanagement beim „intraoperative floppy iris syndrome“

The intraoperative floppy iris syndrome (IFIS) describes an ophthalmologically relevant phenomenon which is observed after systemic intake of alpha blockers for treatment of benign prostate hyperplasia. This leads to an increase in intraoperative complications in cataract surgery characterized by a flaccid iris which billows in response to currents with a tendency to prolapse towards the area of surgery. This results in damage to the iris by the instruments used or posterior capsule rupture with loss of lens material. We describe the preoperative and intraoperative measures and techniques to deal with this challenging situation in order to minimize development of IFIS and reduce the complication rate.

A comparative study of complications of cataract surgery with phacoemulsification in eyes with high and normal axial length

Background:This study performed to assess the safety of cataract extraction with phacoemulsification and intraocular lens (IOL) implantation in patients with high axial length compared with patients with normal axial length.Materials and Methods:A total of 866 eyes were enrolled in this study; all subjects underwent phacoemulsification and IOL implantation for treatment of cataract. Seven hundred and nine eyes fell in the normal group with axial lengths ranging between 21 and 24.5 mm, and 157 eyes were considered myopic with axial length equal or greater than 26 mm. The two groups were compared regarding intraoperative surgical complications, such as vitreous loss, posterior capsular rupture, nucleolus drop, and undesirable implantation of IOL in the anterior chamber.Results:Age was a risk factor in both groups, with each year increase of age, the chance of incidence of intraoperative complications increased 1.04-folds (P = 0.03). And with 1 mm increase in axial length, the incidence of complications raised 1.22-folds (P = 0.007). There was no significant correlation between axial length and incidence of vitreous loss, although the incidence of posterior capsular rupture and nucleus fragment drops increased with increment in the axial length. Sex of the patients and side of the left or right eye were not found to be significant risk factors.Conclusions:As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.

Incidence of intraoperative complications in cataract surgery performed by left-handed residents

To compare the incidence of intraoperative complications during cataract surgery performed by left-handed and right-handed residents and to find predictor variables for complications in resident-performed surgery. Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. This retrospective chart review comprised cataract extractions performed by postgraduate fourth-year residents from July 1, 2001, to June 30, 2006. The incidence of posterior capsule tear and vitreous loss were the main outcomes. Univariate and multivariate logistic analyses incorporated the variables of patient age and sex; laterality of surgical eye; presence of diabetes mellitus, glaucoma, or age-related macular degeneration; history of vitrectomy; axial length; pseudoexfoliation; small pupils; white cataract; posterior polar cataract; handedness of resident; and academic quarter during which surgery occurred. Left-handed residents performed 170 (9.8%) of the 1730 surgeries. The incidence of posterior capsule tear and vitreous loss was significantly lower in surgeries performed by left-handed residents than in those performed by right-handed residents (P = .03 and P<.001, respectively). Multivariate logistic analysis showed that resident right-handedness and older patient age were predictive of an increased incidence of posterior capsule tear and vitreous loss. A small pupil was predictive of an increased incidence of vitreous loss. The incidence of posterior capsule tear and vitreous loss was significantly lower in cataract surgeries performed by left-handed residents. Handedness and patient age were significant predictor variables for these complications.

Evaluation of phacoemulsification in patients with exfoliation syndrome

目的 评价剥脱综合征眼行白内障超声乳化人工晶状体植入术的安全性.方法对剥脱综合征6例(8眼)及50岁以上单纯白内障60例(66眼)行超声乳化人工晶状体植入术,观察分析术中并发症的发生情况及术后眼部变化.结果剥脱综合征术中无后囊破裂;非剥脱综合征眼发生后囊破裂1眼,占1.52%.两组间差异无显著意义(P＞0.05).剥脱综合征眼术中无晶状体悬韧带断裂;非剥脱综合征眼发生1眼,占1.52%.两组间差异无显著意义(P＞0.05).两组病例均未发生术后人工晶状体移位,亦未发现剥脱综合征术后眼内反应明显重于非剥脱综合征眼.结论剥脱综合征眼行超声乳化人工晶状体植入术是安全的.术前充分认识及估计术中的风险,谨慎操作,就可以避免各种并发症的发生。

Managing intraoperative complications in cataract surgery.

This article surveys the literature from 2002 and 2003 and addresses a variety of complications that may arise during cataract surgery. Modern surgical techniques and technology contribute to the decreased incidence of complications. Surgeon experience, early recognition of potential complications, and optimal handling of events lead to better outcomes. Recognizing eyes preoperatively that are particularly at risk for having dysgenesis of the capsular bag, cortical-capsular adhesions, low endothelial cell reserve, dropped nucleus, and bag-lens dislocation will allow for contingency planning and appropriate tailoring of techniques. Capsular tension rings are indispensable for achieving in-the-bag implantation in the presence of weak zonules and zonulolysis. Viscolevitation to rescue sinking implants, avoidance of foldable lens complications, and proper lens placement with an open capsule are discussed. High-frequency ultrasound biomicroscopy is a useful diagnostic tool. Noninjection sub-Tenon anesthesia is not benign. Complications have been documented that include traumatic optic neuropathy. Immediate diagnosis and a trial of corticosteroids could be vision saving. Mastering topical anesthesia is a worthy goal. In some cases, faulty instruments result in complications. Routine inspection of reusable instruments, or the use of disposable instruments is warranted. Though there is no FDA-recognized use, at the time of this writing, for trypan blue dye, it has become the world standard for intraocular staining because of its safety and efficacy. Clear corneal self-sealing incisions are increasingly mainstream and, when properly constructed, are extremely secure. The most significant trend for successful management of intraoperative complications this year is the increasing use of pars plana anterior vitrectomy. The ability to identify prolapsed vitreous by intracameral Kenalog staining is an invaluable tool. Surgeons depend on a team of nurses and technicians for optimal outcomes. With new technology and techniques highlighted by capsular tension rings, Kenalog vitreous identification, and fourth-generation fluoroquinolones, even complicated cataract surgery can result in optimal outcomes.

Pseudoexfoliation Syndrome: A Cohort Study on Intraoperative Complications in Cataract Surgery

Our aim was to determine the rate of intraoperative complications induced by pseudoexfoliation syndrome (PSX) in cataract surgery. We report our experience regarding 1,052 consecutive patients who underwent phacoemulsification. Exact logistic regression was used to examine the role of PSX in intraoperative complications. Odds ratio for intraoperative complications (vitreous loss, capsular break, zonular break) was estimated to be 5.1 for PSX present as compared to when it is absent. PSX was associated with a statistically significant increase in intraoperative complications during cataract surgery (p < 0.0001).