Posterior Capsule Rupture Rates Research Articles

Cataract Surgery in Eyes With Nanophthalmos and Relative Anterior Microphthalmos

To compare the refractive outcome and postoperative complications of cataract surgery among nanophthalmos and relative anterior microphthalmos and the normal control eyes. Retrospective case-control series. Seventeen eyes with nanophthalmos, 29 eyes with relative anterior microphthalmos, and 54 normal control eyes were enrolled in this study. The subjects were divided into 3 diagnostic subgroups according to the following: nanophthalmos with an axial length <20.5 mm and without morphologic malformation; relative anterior microphthalmos with a corneal diameter (CD) ≤ 11 mm, an anterior chamber depth (ACD) ≤ 2.2 mm, and an axial length (AL) ≥ 20.5 mm; and normal control group eyes defined as an AL ≥ 20.5 mm with a CD >11 mm or an ACD >2.2 mm. The implanted intraocular lens (IOL) power was used to calculate the predicted postoperative refraction error according to 4 IOL power formulas: SRK II, SRK/T, Hoffer Q, and Holladay 1. With each formula, the mean numeric error and mean absolute error were calculated. At postoperative 2 months, the endothelial cell count and the complications were analyzed. As measured by mean numeric error or mean absolute error, there was a significant difference among the 3 groups based on SRK II, SRK/T, and Hoffer Q, with less predictability in the nanophthalmic eyes. In eyes with nanophthalmos, the Holladay 1 produced the best refractive results as measured by mean numeric error (P < .001). A higher occurrence rate of posterior capsule rupture (11.7%) was shown in the nanophthalmic eyes. The difference among the 3 groups for the postoperative endothelial cell loss was not significant (P = .421). The refractive predictability and postoperative outcome was poorer in the eyes with nanophthalmos compared to the eyes with relative anterior microphthalmos or normal control.

Approaches to a posterior polar cataract

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection – instead performing ‘inside-out’ hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract.

The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture

To develop a methodology for case-mix adjustment of surgical outcomes for individual cataract surgeons using electronically collected multi-centre data conforming to the cataract national data set (CND). Routinely collected anonymised data were remotely extracted from electronic patient record (EPR) systems in 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were carried out to risk adjust outcomes for posterior capsule rupture rates for individual surgeons, with stratification by surgical grade. A total of 406 surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations between November 2001 and July 2006 (86% from January 2004). In all, 283 surgeons contributed data on >25 cases, providing 54,319 operations suitable for detailed analysis. Case-mix adjusted results of individual surgeons are presented as funnel plots for all surgeons together, and separately for three different grades of surgeon. Plots include 95 and 99.8% confidence limits around the case-mix adjusted outcomes for detection of surgical outliers. Routinely collected electronic data conforming to the CND provides sufficient detail for case-mix adjustment of cataract surgical outcomes. The validation of these risk indicators should be carried out using fresh data to confirm the validity of the risk model. Once validated this model should provide an equitable approach for peer-to-peer comparisons in the context of revalidation.

The Cataract National Dataset Electronic Multi-centre Audit of 55,567 Operations: Variation in Posterior Capsule Rupture Rates between Surgeons

The Cataract National Dataset Electronic Multi-centre Audit of 55,567 Operations: Variation in Posterior Capsule Rupture Rates between Surgeons

Clinical Cystoid Macular Edema After Cataract Surgery in Glaucoma Patients

To determine the prevalence of and risk factors for developing clinical cystoid macular edema (CME) after cataract surgery in patients with glaucoma.Medical records of patients who had cataract surgery between April 1998 and July 2006 without prior history of CME, a known risk factor to develop CME, or previous nonglaucoma ocular laser procedures or intraocular surgeries were reviewed. Clinical CME was diagnosed by fundus examination within 3 months postoperatively and confirmed with fluorescein angiography or optical coherence tomography. Outcome measures included prevalence of clinical CME by comparing patients with and without glaucoma; and risk factor analysis for clinical CME by comparing patients who did and did not develop CME after cataract surgery.Seven hundred patients (eyes) with glaucoma and 553 patients (eyes) without glaucoma were included. The prevalences of clinical CME in glaucoma and nonglaucoma patients were 5.14% and 5.79%, respectively (P=0.618). Patients who developed clinical CME (68 patients) had statistically higher rates of posterior capsule rupture or required anterior vitrectomy during surgery (P=0.010, odds ratio=3.35, 95% CI 1.33-8.45) compared with patients who did not develop clinical CME (1185 patients). No glaucoma medications used either preoperatively or postoperatively were associated with clinical CME (P>0.05).Rupture of posterior capsule and anterior vitrectomy during cataract surgery is a potential risk factor for developing clinical CME after cataract surgery. There is no statistically significant difference in the prevalence of clinical CME after small corneal incision phacoemulsification cataract surgery between glaucoma and nonglaucoma patients.

The Cataract National Dataset Electronic Multi-centre Audit of 55 567 Operations: variation in posterior capsule rupture rates between surgeons

To demonstrate variations in posterior capsule rupture (PCR) rate between surgeons of the same and different grades as a by-product of routine clinical care. NHS departments using electronic medical record (EMR) systems to collect the Cataract National Dataset (CND) were invited to submit data. Data were remotely extracted, anonymised, assessed for conformity and completeness, and analysed for rates of PCR for individual surgeons within each of the three grades. Data were extracted on 55,567 cataract operations performed at 12 NHS trusts by 406 surgeons between November 2001 and July 2006. Data on the grade of 404 of the 406 surgeons who contributed to the study were available for 55,515 cases (99.9%) and were used for this analysis. Variation in PCR rate between surgeons was highest for the most junior grade of surgeon and between those surgeons contributing relatively few cases to the data set. Variation in PCR was lowest among experienced surgeons contributing large numbers of cases to the data set. Considerable variation in PCR rate exists both between and within surgical grades. Routine electronic collection of the CND allows detailed analysis of variations in PCR rates between individual surgeons. To define acceptable limits for this benchmark complication of cataract surgery, further work is needed to adjust surgeons' outcomes for the case mix complexity.

Clinical cystoid macular edema after cataract surgery in glaucoma patients.

To determine the prevalence of and risk factors for developing clinical cystoid macular edema (CME) after cataract surgery in patients with glaucoma. Medical records of patients who had cataract surgery between April 1998 and July 2006 without prior history of CME, a known risk factor to develop CME, or previous nonglaucoma ocular laser procedures or intraocular surgeries were reviewed. Clinical CME was diagnosed by fundus examination within 3 months postoperatively and confirmed with fluorescein angiography or optical coherence tomography. Outcome measures included prevalence of clinical CME by comparing patients with and without glaucoma; and risk factor analysis for clinical CME by comparing patients who did and did not develop CME after cataract surgery. Seven hundred patients (eyes) with glaucoma and 553 patients (eyes) without glaucoma were included. The prevalences of clinical CME in glaucoma and nonglaucoma patients were 5.14% and 5.79%, respectively (P=0.618). Patients who developed clinical CME (68 patients) had statistically higher rates of posterior capsule rupture or required anterior vitrectomy during surgery (P=0.010, odds ratio=3.35, 95% CI 1.33-8.45) compared with patients who did not develop clinical CME (1185 patients). No glaucoma medications used either preoperatively or postoperatively were associated with clinical CME (P>0.05). Rupture of posterior capsule and anterior vitrectomy during cataract surgery is a potential risk factor for developing clinical CME after cataract surgery. There is no statistically significant difference in the prevalence of clinical CME after small corneal incision phacoemulsification cataract surgery between glaucoma and nonglaucoma patients.

Determinants of cataract surgical opportunities and complication rates in UK higher specialist training

The volume of cataract surgery performed by trainee ophthalmologists in the UK, and the complication rates experienced by those trainees is unknown. As a result, no appropriate audit benchmark exists for trainees or their trainers. This study describes the surgical opportunities and rates of posterior capsule rupture (PCR) experienced by higher specialist trainees in one UK training region and explores influencing factors. Number of cataract operations and episodes of PCR in each calendar month were recorded from surgical logbooks for all Specialist Registrars (SpRs) who had completed at least 6 months of training by January 2007. Dates and details of the posts in which the surgery was performed were also recorded. Data from 475 completed months were collected from 19 trainees including 4322 cataract operations and 99 episodes of PCR. Trainees performed a mean 9.1 operations per month. This varied significantly between different subspeciality posts; the fewest cataracts were on paediatric and oculo-plastic firms. District General Hospitals offered more surgery than Teaching Hospitals; mean 10.9 vs 8.5 cataracts per month (P=0.005). No difference in surgical opportunity was found between male and female trainees. An overall PCR rate of 2.3% (95% CI 2.25-2.33%) was found, which decreased significantly with increasing experience (P<0.01). SpRs in Yorkshire expect to complete around 500 cataract operations in their 4.5 years of training. A PCR rate of 2.3% was found for trainees with a mean of 25 months higher specialist training which compares favourably with published series of trainees from other countries.

Cataract surgery: benchmarks for established and trainee surgeons

Much attention is currently focused on surgical outcomes, with policy clearly in favour of the publication of individual results for consultant surgeons.1, 2, 3 Approximately a quarter of cataract surgery in the NHS is, however, undertaken by trainees at specialist registrar (SpR) level,4 which amounts to around 75 000 operations annually in England alone. It is accepted that posterior capsule rupture (PCR) rates for learners are higher than those for experienced phacoemulsification surgeons—an unsurprising finding.5, 6 With this number of procedures being undertaken in the NHS by trainees, it is a matter of public health relevance to know what complication rates should be expected for this group of training surgeons.

La phacoémulsification chez les patients atteints de cataracte blanche : résultats et complications

To compare visual acuity and complications in phacoemulsification in eyes with white cataract and in eyes with immature senile cataract.This was a prospective study on 36 eyes in 34 patients with white cataract (group 1) and 36 eyes in 36 patients with immature senile cataract (group 2).In group 1, mean preoperative visual acuity was 1/100 and mean postoperative visual acuity was 5/10 at 1 month. Posterior capsule tears occurred in four eyes (11%). In group 2, mean preoperative visual acuity was 2/10 and mean postoperative visual acuity was 7/10 at 1 month. No posterior capsule tear was observed. The preoperative visual acuity was significantly lower in group 1 (p=1.8x10(-14)). Postoperative visual acuities were not significantly different between the two groups (p=0.07). The increase in visual acuity was significantly higher in group 1 (p=2.2x10(-11)).Our study shows that white cataract is not a risk factor of poor postoperative visual acuity and the increase in visual acuity is greater in the white cataract group than in the immature cataract group.The results of phacoemulsification in white cataracts are satisfactory in spite of a high rate of posterior capsule rupture in our study.

Prospective Multicenter Evaluation of Cataract Surgery in Patients Taking Tamsulosin (Flomax)

Intraoperative floppy iris syndrome (IFIS) caused by systemic alpha-blockers has been associated with an increased risk of cataract surgical complications when the surgeon was unaware of the medication history and did not anticipate its occurrence. This study was undertaken to evaluate the surgical outcomes and rate of complications when the ophthalmologist knew the patient was taking tamsulosin (Flomax, Boehringer-Ingelheim Pharmaceuticals, Ridgefield, CT) and used 1 of several strategies to manage IFIS. Prospective multicenter nonrandomized observational series. A total of 167 consecutive eyes in 135 patients taking tamsulosin and undergoing cataract surgery. Phacoemulsification was performed in conjunction with at least 1 of 4 different IFIS management strategies, namely, topical atropine preoperatively, iris retractors, pupil expansion ring, or use of viscoadaptive ophthalmic viscosurgical device with reduced fluidic parameters. Severity of IFIS, incidence of operative or postoperative complications, and final visual acuity. The IFIS severity was rated as mild in 17%, moderate in 30%, and severe in 43% of the study eyes. No IFIS was noted in 10% of the eyes. The rate of posterior capsule rupture and vitreous loss was 0.6% (1/167; 95% confidence interval, 0%-1.8%). Ninety-five percent of eyes achieved a best-corrected visual acuity of at least 20/40. When experienced surgeons could anticipate IFIS and employ compensatory surgical techniques, the complication rate from cataract surgery was low and the visual outcomes were excellent in eyes of patients with a history of tamsulosin use.

Rates of Posterior Capsule Rupture During Cataract Surgery Among Different Races in Singapore

The aim of this study was to determine if racial differences exist in the rate of posterior capsule rupture (PCR) during cataract surgery in Singapore. All intraoperative complications during cataract surgery were prospectively reported as part of a clinical audit programme. A retrospective review of all patients who sustained a PCR during cataract surgery between July 1995 and December 1998 was performed. Of 8230 consecutive eyes which underwent cataract surgery, 6951 (84.5%) were Chinese, 597 (7.3%) were Malay, 524 (6.4%) were Indian, and 158 (1.9%) were of other races. The overall incidence of PCR was 1.9%. The PCR rates were 1.8% [125 of 6951; 95% confidence interval (CI), 1.49 to 2.11] in Chinese, 2.0% (12 of 597; 95% CI, 1.01 to 3.57) in Malay, 2.7% (14 of 524; 95% CI, 1.13 to 3.56) in Indian, and 2.5% (4 of 158; 95% CI, 0.00 to 4.98) in other races. There was no statistical difference between the PCR rates (P = 0.62, chi-square test). Racial differences in Singapore do not have an effect on the rates of PCR during cataract surgery.

Effect and outcomes of posterior capsule rupture in a district general hospital setting

To assess how patients from a district general hospital population were affected on a short-term basis after posterior capsule (PC) rupture during phacoemulsification cataract surgery. Department of Ophthalmology, Raigmore Hospital, Inverness, United Kingdom. This retrospective audit encompassing a 2-year period evaluated the incidence of PC rupture and its outcomes. Details of the patients' age, preoperative and final postoperative best corrected visual acuity (BCVA), ocular comorbidity, surgeon grade, number and duration of follow-up reviews, and postoperative complications were collected. Over the 2-year period, the PC rupture rate was 1.7% (45 PC ruptures in 2727 phacoemulsification cataract procedures). Thirty-eight eyes (84.4%) achieved a final BCVA of 6/12 or better. In 39 eyes (86.7%), final BCVA improved compared with BCVA at presentation. Mean duration of follow-up was 11.7 weeks. The most common extra procedure was anterior vitrectomy (64.4%). The most common postoperative complication was raised intraocular pressure (IOP) (exceeding 30 mm Hg) on the first postoperative day (20.0%) despite additional acetazolamide as prophylaxis. None developed infective endophthalmitis. Apart from 1 retinal detachment (2.2%) at week 27, all complications resolved by 19 weeks. No patient required additional long-term medication at the final visit. Posterior capsule rupture impacted on the patient in the short-term in terms of additional surgical procedures, additional topical and oral medications, and number and duration of follow-up reviews. Most patients recovered an acuity of 6/12 or better. However, it is important to be vigilant of postoperative complications, especially raised IOP on the first postoperative day.

Cataract Surgery Combined with Intravitreal Injection of Triamcinolone Acetonide

To evaluate whether the addition of cataract surgery to an intravitreal injection of triamcinolone acetonide markedly increases frequency and spectrum of complications. The comparative nonrandomized clinical interventional investigation included a study group of 60 eyes (56 patients) undergoing cataract surgery and additionally receiving an intravitreal injection of about 20 mg of triamcinolone acetonide and a triamcinolone control group of 290 eyes (262 patients) that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide without cataract surgery. Reasons for intravitreal injection of triamcinolone acetonide were exudative age-related macular degeneration (n=228; 65%), diffuse diabetic macular edema (n=94; 27%), central retinal vein occlusion (n=17; 5%), and branch retinal vein occlusion (n=11; 3%). Mean follow-up was 8.6+/-6.8 months. A second control group included 1068 patients (1068 eyes) who consecutively underwent routine cataract surgery without intravitreal injection. Study group and triamcinolone control group did not vary significantly in best visual acuity during follow-up (p=0.08), final visual acuity at the end of follow-up (p=0.30), maximal intraocular pressure during follow-up (p=0.99), frequency of an intraocular pressure higher than 21 mmHg (p=0.66), and intraocular pressure at the end of follow-up (p=0.06). Postoperative infectious endophthalmitis, wound leakage or other corneal wound healing problems, persisting corneal endothelial decompensation, rhegmatogenous retinal detachment, marked postoperative pain, or a clinically significant decentration of the intraocular lens were not observed. Study group and the non-triamcinolone control group did not vary significantly in the rate of posterior lens capsule rupture (p=0.11), postoperative infectious endophthalmitis, and persisting postoperative corneal endothelial decompensation. The addition of cataract surgery to an intravitreal injection of triamcinolone acetonide may not markedly increase amount and frequency of side effects and complications of intravitreal triamcinolone acetonide. No safe conclusions can be reached regarding differences in frequency of postoperative infectious endophthalmitis.

Modifications in cataract surgery for the morbidly obese patient

We describe a standing phacoemulsification technique (SPT) with the patient in reverse Trendelenburg position (RTP) as a means of performing surgery in morbidly obese patients. These patients have elevated vitreous pressure, leading to a high rate of posterior capsule rupture and vitreous loss. The SPT with RTP normalizes vitreous pressure, facilitating cataract surgery.

Unexpected posterior capsule rupture with unfolding silicone plate-haptic lenses

Purpose: To evaluate the incidence, management, and long-term outcomes of unexpected posterior capsule rupture during injection of a C11UB plate-haptic silicone intraocular lens (IOL) with the Passport ® II system (both Bausch & Lomb Surgical). Setting: Tertiary referral center and teaching hospital. Methods: This retrospective analysis comprised 24 cases of posterior capsule rupture during plate-haptic silicone IOL injection. Results: Over 6 months, a C11UB IOL was injected after phacoemulsification in 3446 cases, from which 24 patients were drawn. Thus, the rate of posterior capsule rupture was 0.70%. The median preoperative best corrected visual acuity was 6/48 (range 6/12 to light perception). The median best spectacle-corrected acuity at the time of discharge or the last visit was 6/9 (range 6/4 to 6/24). Twenty patients had improved acuity, 2 lost 1 Snellen line, and 2 had unchanged acuity. There were no postoperative complications in 13 patients (54%). Three patients required further surgery. Twenty-one patients were discharged after a mean of 32 weeks ± 22 (SD); they required a mean of 5 ± 4 visits. The remaining 3 continue to be followed because of their preoperative ocular comorbidity. Conclusions: Although no predisposing factor was identified, we believe the risk for posterior capsule rupture during IOL injection can be minimized by careful injection technique. In particular, if there is doubt about the integrity of the zonules, anterior capsule, or posterior capsule, a plate-haptic silicone IOL should not be injected. With the appropriate management, the final visual outcome was good.

Phacoemulsification cataract surgery and unplanned anterior vitrectomy--is it bad news?

The aim of this study was to determine the final visual outcome of patients who undergo complicated phacoemulsification cataract surgery in which the posterior capsule is compromised and vitrectomy was required. Data were collected for patients operated on over an 18-month period from the 1st of January till the 24th of June 1999 at the Department of Ophthalmology, Leicester Royal Infirmary. All grades of surgeons were included and patients were identified from the theatre logbook. A standard proforma was completed and the data evaluated. A total of 2538 phacoemulsification cataract operations were performed over this duration. Of these, 2446 (96.4%) had uncomplicated phacoemulsification cataract surgery while 92 (3.6%) required anterior vitrectomy. In order to allow for a more accurate interpretation of the visual outcome, patients were divided into two groups, depending on whether or not there was pre-existing eye disease at initial listing.Sixty-five patients did not have pre-existing eye disease. From this, notes were available for 57 patients, whereby the best-corrected visual acuity (BCVA) was obtained postoperatively. Vision of 6/12 or better was used to define acceptable postoperative vision. This group consisted of 49 patients (86%): five had visual acuities of 6/12, 26 = 6/9, one = 6/7.5 and 17 = 6/6. There were eight (14%) patients with poor visual outcome, largely represented by patients with cystoid macular oedema (8.8%). The most frequent stage of vitreous loss was during primary phacoemulsification in 46 (50%). Irrigation and aspiration, which resulted in 21 (23%) instances, followed this. The rate of posterior capsule rupture and anterior vitrectomy during phacoemulsification cataract surgery is 2% when performed by consultants, 4% by specialist registrars and staff grades and 10% by senior house officers. This study looks at the final visual outcome of patients who underwent unplanned anterior vitrectomy during routine phacoemulsification cataract surgery, in a university teaching hospital in the United Kingdom. It includes all levels of surgeons with varying experience. The rate of vitreous loss in this study for phacoemulsification cataract surgery is 3.6%. Patients who undergo complicated phacoemulsification cataract surgery do comparatively well.

Topical anesthesia for cataract surgery: a population-based perspective

Purpose To analyze the anesthetic regimen and sedation in a population-based cohort of unselected cataract surgery cases operated on with the goal of maximizing the percentage of patients with topical anesthesia and no sedation. Setting Department of Ophthalmology, Norrlands University Hospital, Umeå, Sweden. Methods This prospective observational population-based study comprised all patients having cataract surgery during a 1 year period at 1 institution. Data were collected from the patients’ records, which were standardized. Outcome measures were use of preoperative sedation, type of anesthesia, intraoperative complications, and adverse events. Results The study comprised 890 cases performed by 4 surgeons. Seventy-two percent of patients had no sedation and topical anesthesia only. All patients except 1 who had previous cataract surgery with topical anesthesia chose the same method for their second-eye surgery. The rate of posterior capsule rupture was in the expected range for a population with high incidences of pseudoexfoliation and mature cataract. Conclusions It is possible to achieve a high percentage of effective topical anesthesia for cataract surgery in a population-based setting. The findings have implications for cost-containment in health services.

Erbium:YAG laser cataract removal: Role of fiber-optic delivery system

Purpose: To review the properties of energy delivery systems and to evaluate the efficiency of zirconium-fluoride-based and sapphire fibers delivering erbium:YAG (Er:YAG) laser energy in a clinical laser cataract surgery system. Setting Department of Ophthalmology, Medical College of Virginia Campus of Virginia Commonwealth University, and Veterans Affairs Medical Center, Richmond, Virginia, USA. Methods: Thirty-two patients had Er:YAG laser cataract extraction. Preoperativevisual acuity ranged between finger counting and 20/40 secondary to cataract. The endothelial cell count was measured preoperatively and 6 weeks after surgery. A zirconium-fluoride-based fiber was used in 23 patients and a sapphire fiber in 9 patients. Results: Of the patients examined after 3 months (n = 31), 90.3% (n = 28) had avisual acuity of 20/30 or better and 9.7% (n = 3), of 20/40 or 20/50. Mean endothelial cell loss at 6 weeks was 7.6% ± 12.8 (SD). Posterior capsule rupture with vitreous loss occurred in 3 cases; 1 was attributed to laser damage to the capsule. Conversion to ultrasound phacoemulsification was required in 13 cases. Suitable fiber materials for Er:YAG laser delivery are sapphire, zirconium fluoride, silica, and germanium oxide. Toxicity of the latter is under investigation. Conclusion: The Er:YAG laser emulsified the lens nucleus safely and effectively. These early results include a higher than acceptable posterior capsule rupture rate and reflect the surgeon's learning curve with a new technology. Effective power delivery can be achieved with sapphire- and zirconium-fluoride-based fiber optics through a silica tip. The optimal energy delivery system has not been determined.

Surgical outcomes of cataract extractions performed by residents using phacoemulsification

Purpose: To assess whether changes in surgical technique, resident training, and phacoemulsification equipment affected the complication rate for cataract extractions performed by residents.Setting: Combined urban and rural setting at a tertiary care academic center and a general care Veterans Administration Hospital, Salt Lake City, Utah, USA.Methods: This retrospective study analyzed 396 patients who had cataract surgery by phacoemulsification and intraocular lens implantation performed by four residents. The residents' first 50 cases were compared with the last 50 cases performed at the end of their training. Surgical and 1 day postoperative complications were examined.Results: Twenty of 396 surgical cases (5.1 %) involved complications, and the overall vitreous loss rate for the four residents was 1.8%. A statistically significant difference was observed between the two residents with the highest and lowest number of intraoperative complications (P < .05) and between the two residents with the highest and lowest number of 1 day postoperative complications (P < .05). The rate of posterior capsule rupture with vitreous loss was 2.6% in the residents' early cases; the decrease to no cases of posterior capsule rupture in the late cases was also statistically significant (P < .02).Conclusion: The results indicate that with proper training and supervision, residents can obtain an acceptably low complication rate using phacoemulsification. As their skill increased, they were able to use phacoemulsification successfully on more complicated cases. Individual skill was also an important factor in the complication rate.