Nine-point scale preoperatively assesses difficulties, risks of phaco

Ophthalmic Surg Lasers Imaging. 2009;40(4):361-365.

A basic grading system proved effective in preoperatively gauging the difficulty of phacoemulsification, a study showed.

The grading system was designed to accurately describe individual cases, expedite the referral of varying cases to qualified staff members, inform patients and generate precise data for research, the study authors said.

"If adopted by more surgeons, the score will be an excellent way to analyze the real importance of the cataract procedure and to assess any score changes over time that result from advances in surgical techniques," they said.

The prospective study included 400 patients undergoing phacoemulsification. The grading system included nine anatomic parameters: orbit, cornea, retinal red reflex, iris, anterior chamber depth, mydriasis, nuclear hardness, zonule and capsule.

A higher score for each parameter denoted greater surgical difficulty related to that parameter. A final cumulative score comprised a sum total of all nine scores. The difficulty of procedures was based on a five-level scale, with 1 denoting low difficulty and 5 signifying extremely high difficulty.

Fifty-five percent of cases showed a low and medium-low level of difficulty. Thirty percent of cases showed medium-high and high levels of difficulty. Fifteen percent of cases showed extremely high difficulty.

Study data showed a firm association between preoperative scores and intraoperative surgical difficulty, the authors said.

The scale did not include patient age, level of cooperation or type of anesthesia used.