Challenging phaco cases may increase risk of complications for residents

Ophthalmology. 2009;116(3):431-436.

Ophthalmic residents performing phacoemulsification generally achieve good results, but cases identified preoperatively as challenging may increase the risk of complications.

According to researchers looking at the electronic medical records of 320 consecutive eyes undergoing cataract extraction by surgical residents at a single institution, major intraoperative complications were rare, occurring in just 15 cases (4.7%). The predominant complication reported in the series was vitreous loss, which occurred in 10 cases (3.1%).

Minor complications occurred in 28 cases (8.8%), with 18 cases of failure of a complete curvilinear capsulorrhexis and eight cases of intraoperative iris prolapse.

In multivariate analysis, cases identified preoperatively as challenging were more likely to have a complication. For instance, presence of a 4+ nuclear sclerotic cataract (odds ratio = 18.9) or zonular pathology (odds ratio = 26.2) significantly increased the risk of complications.

When a surgical complication occurred, the risk of achieving poorer visual outcome increased. Only 71% of eyes that had a major intraoperative complication achieved 20/40 or better vision after surgery compared with 95% of eyes without complications.

Challenging cases were defined as small pupil, potential zonular pathology, mature cataracts, combined cases, shallow chambers, corneal problems, post-vitrectomy cataracts and monocular patients. Major intraoperative complications were defined as vitreous loss; corneal wound burn; suprachoroidal hemorrhage; vitreous hemorrhage, retinal detachment or endophthalmitis occurring within 90 days after surgery; and complications requiring another operation within 90 days.