Rate Of Posterior Capsular Rupture Research Articles

Outcomes of Cataract Surgery Complicated With Zonular Dialysis: A Multicenter Comparative Study

Purpose To compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes. Methods A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12–24 weeks and the rates of CME and additional associated complications. Results We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group (p < 0.001). Mean postoperative VA was worse in the ZD group (p < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4–12 weeks and 12–24 weeks, respectively. At 12–24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group (p < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% (p = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal. Conclusions The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME.

Learning curves of novice residents on cataract surgery simulator: the E3CAPS pedagogic study

IntroductionTraining novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents.MethodsThis prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed.ResultsSixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the “emulsification” step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during “emulsification” and from 69 to 0% during “irrigation and aspiration”. At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall.ConclusionA training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. Trial registrationClinicalTrials registration number: NCT05722080 (first submitted 22/12/2022, first posted 10/02/2023).

Comparison of posterior capsular rupture rates during phacoemulsification using 3D heads-up visualization system and traditional microscopes.

To compare the posterior capsular rupture (PCR) rates of cataract surgery using a traditional ophthalmic surgical microscope (OSM) and a three-dimensional (3D) heads-up visualization system (HUVS). Single tertiary referral center. Retrospective study. This study included 10,101 eyes that underwent phacoemulsification cataract surgery. Surgeries were performed using either 3D HUVS (1,964 eyes, performed by two surgeons, HUVS group) or traditional OSM (8,137 eyes, performed by six surgeons, OSM group) from February 2018 to June 2022. Data were collected based on the diagnosis-related group system, and the rate of PCR requiring vitrectomy and the surgical time were evaluated. The PCR rates were not significantly different between the OSM (n = 63; 0.7%) and HUVS (n = 19; 0.9%, p = 0.392) groups. The mean surgical times was significantly longer in the HUVS group (14.7 ± 10.6 min) than in the OSM group (12.9 ± 9.9 min, p < 0.001). In the 3D HUVS group, there were no PCR cases among the initial 100 patients. In both groups, no significant difference was observed in the PCR rates over time. Although the difference was not statistically significant, the PCR rate decreased over time in the HUVS group. Our results indicate that 3D HUVS-based cataract surgery performed by experienced cataract surgeons had a PCR rate similar to that of traditional OSM-based surgery during the 4-year study period. Although the surgical time was slightly longer with 3D HUVS, cataract surgery using 3D HUVS can be performed safely by experienced surgeons.

Posterior Capsular Rupture during Cataract Surgery in Eyes Previously Treated with Intravitreal Injections

Introduction: Intravitreal injections (IVIs) are currently the most common intraocular surgical procedure worldwide. Some studies have reported a higher risk of intraoperative complications, namely, posterior capsular rupture (PCR), during cataract surgery. The aim of this retrospective and observational study, conducted at Department of Ophthalmology, Centro Hospitalar Universitário do Porto, was to assess the risk of PCR during cataract surgery in eyes previously treated with IVIs with anti-vascular endothelial growth factor (anti-VEGF) and/or corticosteroids. Methods: Eyes undergoing cataract surgery between June 2019 and May 2021 were included. Combined surgeries, such as glaucoma surgery and pars plana vitrectomy, were excluded. The occurrence of PCR during cataract surgery in treated and previously untreated eyes with IVI was analyzed. Results: A total of 5,813 cataract surgeries were analyzed; 4.1% of the cases had previously undergone IVI. The PCR rate in cataract surgery was 1.8%: 6.7% in eyes previously treated with IVI and 1.6% without previous IVI (OR = 4.5, 95% CI: 2.6–7.7, p < 0.001). The combined therapy (anti-VEGF with corticosteroids) presents a higher risk compared to the two therapies alone as monotherapy (OR = 11.6, 95% CI: 4.7–28.5, p < 0.001), as well as treated eyes treated with ≥10 IVI (OR = 2.1, 95% CI: 0.8–6.1, p = 0.144) and a time interval between the last IVI and cataract surgery was ≤6 months (OR = 1.9, 95% CI: 0.6–6.1, p = 0.296). Conclusion: These results demonstrate that eyes that require IV treatment prior to cataract surgery are at increased risk of CPA during cataract surgery, and careful assessment of the characteristics of the cataract and posterior capsule is critical.

Impact of a structured training program to enhance skills in phacoemulsification surgery.

Purpose:The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases.Methods:This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done.Results:Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1.Conclusion:A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Predictive value of pupillography on intraoperative floppy iris syndrome in preoperative period.

To present the frequency of intraoperative floppy iris syndrome (IFIS) in cataract patients who taking alpha 1-a receptor antagonist (ARA) drugs, and evaluate the predictive value of pupil diameter (PD) changes in IFIS patients. Male cataract patients who are under treatment with alpha-1a-ARAs (alfuzosin, tamsulosin) intraoperatively were evaluated and were grouped as with/without IFIS. The preoperative PD values were compared with controls. Also, the intraoperative manipulations and early/late complications were recorded. A total of 77 patients (77 eyes) of 94 benign prostate hyperplasia (BPH) patients have been defined as IFIS (81.91%) and 40 patients (40 eyes) were taking tamsulosin and 37 patients (37 eyes) were taking alfuzosin. During the cataract surgery, the rate of posterior capsular rupture (P=0.754), vitreous loss (P=0.585), iris tears (P=0.004), and iris catching (P=0.000) were higher in IFIS group, but the difference was significant only in the iris catching. At the postoperative first-month visit, persistent IOP rise and iris stromal tears were more frequent in IFIS group, but the difference was not significant (P=0.311, P=0.146; respectively). In contrast, Descemet membrane detachment was insignificantly more frequent in controls (P=0.311). In IFIS and control patients, PDs were 9.54±1.78 and 9.72±1.57 mm (P=0.255) under scotopic illumination, 8.54±1.43 and 8.74±1.25 mm (P=0.289) under mesopic illumination, 6.99±1.35 and 7.27±1.39 mm (P=0.662) under photopic illumination, respectively. However PDs were lower in IFIS under all illumination degrees, no significant difference was detected between groups. IFIS is a significant clinical syndrome with an increased intraoperative/postoperative complication ratio. The prediction of this syndrome is important because of prevention required precautions against possible complications. There is no association between IFIS and preoperative PD.

Improving the Outcomes of Modified Manual Small Incision Cataract Surgery Using Clinical Audit

Purpose: To use clinical audit in improving the outcomes of manual small incision cataract surgery technique&#x0D; Study Design: Clinical audit.&#x0D; Place and Duration: Layton Rehmatullah Benevolent Trust Eye hospital Karachi, from September 2019 to December 2019.&#x0D; Methods: Two hundred patients who had undergone Manual Small Incision Cataract surgery were selected. Cases with traumatic cataract, weak zonules, pseudoexfoliation, and more than 1 diopter difference in keratometric readings, corneal and retinal pathologies were excluded. Surgical complications and visual outcomes were recorded on the 7th postoperative day. Refractive data was recorded from subjective refraction. Data was analyzed by University Hospital Bristol formula. Standards were set using international literature. Deficiencies were noted and technique was modified to improve the outcome. The audit was repeated after 2 months to see whether modifications had improved the outcome.&#x0D; Results: In the first audit, posterior capsular rupture rate was 1%, corrected visual acuity of 6/12 or better was achieved in 85.36% and surgically induced cylinder of less than 2 DC was achieved in 75.60% of the patients. In the second audit all standards were achieved. Posterior capsular rupture did not occur. Corrected visual acuity of 6/12 or better was achieved in 90.50% and induced cylinder of less than 2 DC was achieved in 87.05% of the patients.&#x0D; Conclusion: Clinical audit of the surgical procedures is a good technique in improving the outcomes of manual small incision cataract surgery.&#x0D; Key Words: Cataract extraction, clinical audit, posterior capsular rupture, astigmatism, visual acuity.

The Latest Evidence with Regards to Femtosecond Laser-Assisted Cataract Surgery and Its Use Post 2020.

Femtosecond laser-assisted cataract surgery (FLACS) was introduced with the hope of making cataract surgery safer and making the refractive result more predictable. It is only in the last four years that level 1 prospective randomised controlled trials (RCT) using current technology have been published. These, along with a meta-analysis of recent studies have shown that there seems to be little long-term visual benefit when using FLACS with monofocal lenses. The promised decrease in ultrasound energy required to remove a cataract has not been consistently demonstrated. There is level one evidence that the rate of posterior capsular rupture is less with FLACS using modern software. The round capsulotomy may be of increasing importance with the uptake of toric, multifocal and extended depth of focus lenses where a predictable capsulotomy size and precise placement of the lens becomes more important.

Cataract surgery in eyes with congenital ocular coloboma.

To assess the safety, efficacy, and complication rate of phacoemulsification and intraocular lens (IOL) implantation in patients with congenital uveal coloboma and to evaluate the role of pupilloplasty. A retrospective review of 41 eyes (31 patients) with congenital coloboma that underwent phacoemulsification and IOL implantation between September 2012 and September 2018. Preoperative, intraoperative, and postoperative data were collected for analysis. The mean patient age at surgery was 53.9years (range 15-82). The primary indication for surgery was cataract removal for visual improvement, and lens subluxation was additionally present in two eyes (5%) preoperatively. The mean preoperative corrected distance visual acuity (CDVA) was 0.90 LogMAR. Phacoemulsification surgery was performed in all cases and nine eyes (22%) had pupilloplasty for pupil reconstitution at the time of the procedure. Surgeon grade varied from trainee surgeon under supervision to consultant. Eight patients (19.5%) had posterior capsular rupture (PCR) with or without vitreous loss requiring anterior vitrectomy. Of these, 2 cases (5%) had dropped nuclear fragments requiring subsequent pars plana vitrectomy and lens fragment removal. The mean postoperative CDVA was 0.62 LogMAR (p = 0.0003). Patients with iridolenticular choroidal coloboma appear to be more at risk of complications, as were cases performed by non-consultant surgeons. Contrary, patients with phakodonesis, preoperative anterior chamber vitreous, dense cataracts, and cases were iris hooks used had no significant difference at PCR rate. The risk of postoperative glare and pupilloplasty needs to be considered in cases with good visual potential to avoid a possible second procedure.

Effect of virtual reality simulation training on real-life cataract surgery complications: systematic literature review.

Virtual reality simulation (VRS) has become progressively popular as a training tool in ophthalmology. However, debate continues as to whether VRS has resulted in better outcomes for patients after cataract surgery. Accordingly, a qualitative systematic literature review was conducted to identify whether VRS training results in a reduced complication rate after real-life cataract surgery. Included studies measured the effect of VRS on real-life patient outcomes after cataract surgery. Databases searched included MEDLINE (Ovid), The Cochrane Library, Web of Science, PubMed, and CINAHL. A total of 1917 studies were identified, of which 10 studies were included, spanning from 2011 to 2020. The studies comprised 471 ophthalmological residents, with their complication rates assessed after 30 462 cataract surgery procedures. This systematic literature review indicates that VRS seems to be most helpful in reducing the rate of posterior capsular rupture or errant curvilinear capsulorrhexis and had limited evidence in reducing the rate of other complications.

Incidence, characteristics, outcomes and confidence in managing posterior capsular rupture during cataract surgery in the UK: an ophthalmology trainees' perspective.

To examine the incidence, characteristics and outcomes of posterior capsular rupture (PCR) cases amongst the ophthalmology trainees and to evaluate the trainees' confidence in managing PCR. A two-staged cross-sectional study was carried out between September 2017 and April 2018 in the North East of England, UK. All ophthalmology trainees were surveyed on their confidence level in managing PCR and the characteristics and outcomes of their PCR cases. Fifteen (71.4%) out of 21 trainees completed the study. The mean number of phacoemulsification was 268.9 ± 250.9 cases (range, 0-705) per trainee. There were 82 (1.9%) cases of PCR reported among 4303 phacoemulsification. PCR occurred most commonly during quadrant removal (44.0%) and cortex removal (21.3%). The best-corrected visual acuity (in logMAR) improved significantly from 0.47 ± 0.32 preoperatively to 0.20 ± 0.19 postoperatively (p < 0.001). The supervising consultant took over 80.5% of the PCR cases. The PCR rate decreased significantly from 3.1% at 0-100 cases to 0.6% at 301-400 cases (p = 0.004) and to 0.4% at >500 cases (p = 0.005). Confidence in managing PCR (without supervision) improved from 0% (9/9) at junior level to 50% (3/6) at senior level, and the average number of anterior vitrectomies performed was 0.6 ± 0.9 (range: 0.0-2.0). We observed a low PCR rate among the trainees in our region, with the majority of cases achieving good visual outcome. A significant reduction in PCR rate was observed at the threshold of >500 cases. There is however a lack of confidence among trainees in managing PCR, highlighting the need for devising new training strategies in this area.

Simulation virtuelle pour l’apprentissage de la chirurgie de cataracte

The training in phacoemulsification cataract surgery in our context requires a long learning curve for a novice surgeon starting from the observation period to the realization of the different operating stages being supervised by a senior surgeon, all under stressful conditions. Topical or locoregional anesthesia limits the communication in the operating room between the novice surgeon and his mentor; thus, increasing the risk of having more operative complications. To reduce the teaching time of cataract surgery, our department has introduced virtual simulator trainings for phacoemulsification. To assess the impact of surgical simulator training on residents' performances. We conducted a prospective comparative study in our department in partnership with a private ophthalmology clinic where the simulator is installed. Twelve residents were included in this study, six of them were randomly selected to participate in the phacoemulsification surgical simulator training while the others never used the simulator. The training lasted 30hours in total. No residents had previous training in phacoemulsification. The parameters studied were: the operating time, the achievement of a circular capsulorhexis of 5-6mm in diameter and well centered, the number of capsular breaks with or without an anterior vitrectomy and finally the accumulated dissipated energy (EDC). The cataract surgery was performed on an Alcon Centurion platform. In the operating room, each resident operated 25cataracts; we compared the two user groups including the simulator and non simulator user and we noticed a statistically significant difference (P<0.05) in terms of average operating time respectively 20minutes and 37minutes. Regarding the realization of capsulorhexis; 22cases of rhexis wandering and 12poorly centred rhexis on 150operated cataracts were identified (22.7%) in the group of residents who received no simulator training versus 10cases in the simulator user group (6.7%). The cumulative dissipated energy (EDC) was significantly lower in the simulator user group (8.1 versus 18.7). The same is true for the rate of posterior capsular rupture, which is higher in the non-user group of simulator 37cases (24.6%) versus 10cases (8%) in the second group. Ophthalmic surgery has benefited from the introduction of endo-ocular surgical simulation tools through simulators of vitreoretinal surgery and phacoemulsification; whose main role is primarily pedagogical because a simulator allows young residents to acquire dexterity and autonomy over a shortened period of time in addition to minimizing the risk of complications. Initial learning of phacoemulsification cataract surgery should be an integral part of the virtual simulator program before moving to the real conditions of the operating room as it allows for better operative performance with a minimal complication rate.

Phacoemulsification in posterior polar cataract: Experience from a tertiary eye care Centre in North India.

Purpose:To determine the rate of posterior capsular rupture (PCR) and assess the postoperative outcomes in patients of posterior polar cataract (PPC) undergoing phacoemulsification using a combination of “V” or “λ” nucleofractis and viscodissection.Methods:It was a retrospective study of 80 eyes of 64 patients undergoing surgery for PPC. All surgeries were performed by a single surgeon. After completion of the continuous curvilinear capsulorrhexis (CCC), controlled hydrodelineation was used to separate the endonucleus from the epinuclear shell with limited viscodissection. Phacoemulsification was then carried out by making a “V” or lambda-shaped nucleofractis with the phaco tip followed by multiple chopping of the nucleus, ensuring the integrity of the epinuclear part of the lens. The epinuclear plate was removed after viscodissection.Results:The overall rate of PCR was 7.5% (6 out of 80 eyes). Of the 6 eyes, 4 eyes had been documented to have a pre-existing posterior capsular defect on slit-lamp examination. The rate of “on table” PCR, that is, PCR occurring intraoperatively was only 2.6% (2 of 76 eyes). Nucleus drop was not encountered in any case. Overall 87.5% eyes achieved a final visual acuity of 20/40 or better with 68.75% being 20/20 or better. Of the eyes developing PCR, two-third achieved a visual acuity of 20/30 or better.Conclusion:Using a combination of surgical techniques of V groove or lambda technique for nucleofractis and removal of epinucleus by viscodissection can result in a low rate of PCR and extremely good postoperative outcomes in cases of PPC.

Reduced posterior capsular rupture rate observed among trainee surgeons utilizing a disposable silicone-tipped irrigation and aspiration handpiece for soft lens removal

ABSTRACTBackground: To determine if there is an association between lower posterior capsule rupture (PCR) rates among trainees using silicone-tipped handpieces compared with trainees using conventional instrumentation.Methods: In a retrospective audit, anonymized data was extracted for two groups of supervised deanery trainees. Group one operated with conventional IA handpieces. Group two utilized silicone-tipped IA handpieces. Risk factors found to increase the likelihood for intraoperative PCR were included in the analysis. Statistical significance was tested using a parametric test of two proportions.Results: Group one performed 782 surgeries and had a PCR rate of 3.6% vs 1.6% from 933 surgeries in group two. Following adjustment for risk factors, the p-value was 0.057. Group two had no IA-related PCR complications vs 12% in group one. Both groups demonstrated highest rates of PCR during phacoemulsification, 48% and 57%, respectively.Conclusion: Group two had lower than expected complication rates compared to the published literature. Trainees utilizing a 45-degree silicone-tipped IA handpiece had a lower rate of PCR and vitreous loss compared to group one and experienced no complications during IA. This suggests silicone-tipped IA handpieces may be safer for soft lens extraction compared to conventional instrumentation.

A Database Study of Visual Outcomes and Intraoperative Complications of Postvitrectomy Cataract Surgery

To analyze the visual outcomes and rate of intraoperative complications of phacoemulsification surgery after prior pars plana vitrectomy (PPV). Retrospective, multicenter database study. Eyes that underwent phacoemulsification between June 2005 and March 2015 at 8 sites in the United Kingdom. Study eyes were classified as vitrectomized (prior PPV group) or nonvitrectomized (reference group) depending on the vitreous state at the time of cataract surgery. Eyes with multiple intraocular surgeries or history of ocular diseases known to cause cataract progression or increased risk of intraoperative complications during phacoemulsification were excluded. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), rate of intraoperative complications, and time interval to cataract surgery. Eyes in the prior PPV group (n= 2221) had worse preoperative logMAR VA (0.96±0.60 vs. 0.62±0.52, P < 0.0001), were from younger patients, and had longer axial lengths than the nonvitrectomized group (n= 136 533). At all postoperative time points measured up to 24 weeks, mean vision was poorer in the prior PPV group (0.41±0.47 vs. 0.17±0.29 at 4-12 weeks, P < 0.0001) and a smaller proportion of eyes achieved postoperative VA ≤0.30 logMAR (Snellen, ≥20/40) (60.8% vs. 86.5% at 4-12 weeks, P < 0.0001). The rate of posterior capsular rupture was not different between the prior PPV (1.5%) and the nonvitrectomized (1.7%) groups, but the incidences of zonular dialysis (1.3% vs. 0.6%) and dropped nuclear fragments (0.6% vs. 0.2%) were higher in the prior PPV group (P < 0.0001). The mean time interval between PPV and cataract surgery was 399 days. We found a significant improvement in VA with postvitrectomy cataract surgery. However, compared with eyes without prior PPV, there was a worse mean postoperative vision of 0.2 logMAR units, a higher rate of zonular dialysis and dropped nuclear fragments, and a similar rate of posterior capsule rupture.

Complications of cataract surgery in eyes filled with silicone oil.

The aim of the study was to evaluate complications of cataract surgery in eyes filled with silicone oil. This retrospective, noncomparative, consecutive case series analyzed medical files of patients with eyes filled with silicone oil undergoing cataract surgery. Phacoemulsification with posterior chamber intraocular lens implantation was conducted with or without concurrent silicone oil removal. In this study, 121 eyes of 120 patients were included. In 32 eyes (26.4%) with evident silicone oil microemulsification or silicone oil-associated open-angle glaucoma, silicone oil was removed prior to phacoemulsification through a pars plana incision and no cases of posterior capsular rupture occurred during the subsequent cataract surgery. In the remaining 89 eyes, phacoemulsification was performed with silicone oil in the vitreous cavity. In these eyes, the rate of posterior capsular rupture was 9/89 (10.1%) and the rate of silicone oil migration into the anterior chamber through an apparently intact posterior capsule was 5/89 (5.6%). In 94 eyes (77.7%), an intraocular lens was inserted into the capsular bag, in 3 eyes (2.5%) into the sulcus, and in 1 eye (0.8%) a transscleral suturing was performed. In this series, complications related to the silicone oil were not uncommon during cataract surgery. In the majority of patients without evident silicone oil microemulsification or silicone oil-associated open-angle glaucoma, cataract surgery and posterior chamber intraocular lens implantation were performed while leaving the silicone oil in place.

Early versus late traumatic cataract surgery and intraocular lens implantation

PurposeTo determine the proper time for traumatic cataract surgery after open globe injuries.SettingFarabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.DesignRandomized clinical trial.Patients and methodsIn a randomized clinical trial, 30 eyes with traumatic cataract after open globe injury with IOL implantation underwent early (in the first week after the trauma) and 30 eyes underwent late cataract surgery (from the first to second month after the trauma). We excluded patients who were under 12-year-old. All patients were visited at 1 week, 4 weeks, 12 weeks, and 6 months after surgery. In each visit, patients were examined regarding visual acuity, intraocular pressure (IOP), anterior chamber inflammation, IOL position, and posterior synechiae. In addition, posterior segment evaluation and fundoscopy were performed. Intraoperative complication including posterior capsular rupture, anterior vitrectomy, and zonulysis as well as the site of IOL implantation were documented and post-operative complications including raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were listed.ResultsBest-corrected visual acuity 6 months after surgery was not different between the two groups. Also in early cataract surgery group, the rate of posterior capsular rupture was not significantly higher than the late surgery group (P=0.069). On the other hand, zonulysis was significantly higher in the late procedure group (P=0.039). Other complications including anterior vitrectomy, raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were not different in the two groups.ConclusionsEarly and late traumatic cataract surgery and IOL implantation after open globe injuries, have no significant difference regarding the post-surgical BCVA and prominent intraoperative and post-operative complications.

The Malaysian Cataract Surgery Registry: risk Indicators for posterior capsular rupture

AimTo identify the risk indicators for posterior capsular rupture (PCR) in the Malaysian Cataract Surgery Registry (CSR).MethodsData from the web-based CSR were collected for cataract surgery performed from 2008 to...

Cataract skills: how do we judge competency?

Cataract skills: how do we judge competency?

Step-by-step phacoemulsification training program for ophthalmology residents

Aims:The aim was to analyze the learning curve of phacoemulsification (phaco) performed by residents without experience in performing extra-capsular cataract extraction (ECCE) in a step-by-step training program (SBSTP).Materials and Methods:Consecutive surgical records of phaco performed from March 2009 to Sept 2011 by four residents without previous ECCE experience were retrospectively reviewed. The completion rate of the first 30 procedures by each resident was calculated. The main intraoperative phaco parameter records for the first 30 surgeries by each resident were compared with those for their last 30 surgeries. Intraoperative complications in the residents’ procedures were also recorded and analyzed.Results:A total of 1013 surgeries were performed by residents. The completion rate for the first 30 phaco procedures was 79.2 ± 5.8%. The main reasons for halting the procedure were as follows: Anterior capsule tear, inability to crack the nucleus, and posterior capsular rupture during phaco or cortex removal. Cumulative dissipated energy of phaco power used during the surgeries was significantly less in the last 30 cases compared with the first 30 cases (30.10 ± 17.58 vs. 55.41 ± 37.59, P = 0.021). Posterior capsular rupture rate was 2.5 ± 1.2% in total (10.8 ± 4.2% in the first 30 cases and 1.7 ± 1.9% in the last 30 cases, P = 0.008; a statistically significant difference).Conclusion:The step-by-step training program might be a necessary process for a resident to transit from dependence to a self-supported operator. It is also an essential middle step between wet lab training to performing the entire phaco procedure on the patient both effectively and safely.