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Dutch improve methods, quality of phaco
Many surgeons have passed the learning curve in the past year.
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VIENNA, Austria — Surgeons in Holland are further along in the learning curve with phaco techniques, experiencing fewer dropped nuclei.
Ype Henry, MD, of The Academy Hospital Vrije University in Amsterdam, Holland, presented results from his annual survey at the European Society of Cataract and Refractive Surgeons meeting in Vienna.
Dr. Henry compared the survey of this year with the one conducted in 1998. He sent a written questionnaire of 37 multiple choice questions to 390 ophthalmologists, of whom 294 completed the survey and 11 returned empty surveys for a 79% response rate. This is comparable to last year’s 82% response rate.
Routines change
In Holland 80,000 cataract operations were carried out in 1998, an increase of 6,000 from 1997. Anesthesia routines have not changed much in recent years, he said. “Retrobulbar injection is still the preferable choice (68%) and topical anesthesia (6%) is only very slightly up than the survey of 1998.”
Most surgeons still use a 12-o’clock incision and few have changed toward the steeper meridian or the temporal approach.
About one-half of the surgeons’ incisions are smaller than 5 mm and the remainder are above 5 mm. Only about 15% routinely use a clear corneal incision.
“Compared with other studies, it’s still quite low,” he said.
Dr. Henry said that 90% of surgeons use phaco in more than 90% of their cases.
“There is quite an increase in 1 year,” he said. “From 72% to 90%, the classic ‘divide and conquer’ technique (4 quadrants) is first choice for 85% of Dutch cataract surgeons.”
Learning curve
They are becoming more flexible with their techniques, and are using foldable lenses more often. Use of PMMA lenses has dropped to almost 50%. “Silicone is more or less the same (with 28%) and the acrylic lenses are coming up a little bit,” he said. Acrylic is routinely used in 14% of cases.
Sutureless surgery now accounts for 61% of procedures.
Just as the methods have improved, so has the quality of surgery. Surgeons reported an endophthalmitis rate of 1.6 cases per thousand, which is comparable with figures from the literature. They also reported a dropped nucleus rate (more than one-quarter of the lens) of 1.5 per thousand, a decrease from 2.5 per thousand from the previous year, Dr. Henry said. This reflects the extra year of experience with phaco.
Holland has only five refractive lasers and so only 8% of surgeons do laser surgery, Dr. Henry said. Because of the many positive reactions and high response rate, Dr. Henry will continue to survey the Dutch cataract surgeons yearly, he said.
For Your Information:
- Ype Henry, MD, practices in the Department of Ophthalmology, Vrije University Hospital, Postbus 7057, 1007 MB Amsterdam, Holland; (31) 20-4444795; fax: (31) 20-4444745; e-mail: y.henry@azvu.nl. Dr. Henry has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.