Intraoperative complications of 1000 phacoemulsification procedures: a prospective study.

PURPOSE: To determine the frequency and nature of intraoperative complications of endocapsular phacoemulsification cataract surgery. SETTING: Dalcross Private Hospital and the Departments of Ophthalmology, Concord Hospital and Prince of Wales Hospital, Sydney, Australia. METHODS: This prospective study included the first 1000 cases of planned endocapsular phacoemulsification cataract surgery performed by an experienced surgeon. A standardized proforma was completed at the time of surgery. Data recorded included pre-existing ocular abnormalities, duration of surgery, nuclear sclerosis grade, and intraoperative complications. RESULTS: Major complications comprised posterior capsule tears with vitreous loss (1.4%), isolated posterior capsule tears (0.7%), and zonulysis (0.1%). Minor complications included anterior capsule tears (3.8%), iris prolapse (0.6%), and ciliary body incision (0.2%). There was a significant trend toward complications as the nuclear sclerosis grade increased. The incidence of major complications was 9.3% in the first 150 cases and 0.9% in the last 850. This represents a relative risk of 9.9 (95% confidence interval 4.2 to 23.0) of a major complication occurring in the first 150 compared with the later 850 cases. CONCLUSION: The frequency of major and minor complications fell sharply after the first 150 operations and was maintained. This study may provide a guide for beginning phacoemulsification surgeons and a basis for experienced surgeons to compare their performance outcomes.

Prospective study of the SI-40NB foldable silicone intraocular lens.

PURPOSE: To evaluate the surgical performance and postoperative outcomes of 100 consecutive implantations of the new AMO PhacoFlex SI-40NB foldable intraocular lens (IOL). SETTING: Concord Hospital and Dalcross Private Hospital, Sydney, Australia. METHODS: This prospective study comprised 100 consecutive patients who had endocapsular phacoemulsification cataract surgery with implantation of the AMO SI-40NB IOL, which has a silicone optic and poly(methyl methacrylate) (PMMA) haptics. Patients were excluded if trabeculectomy was performed concomitantly. The main outcome measures were control of folding, ease of implantation, centration, intraoperative and postoperative complications, and visual acuity. A minimum of 4 months follow-up was planned. RESULTS: Mean follow-up was 4.3 months +/- 2.1 (SD) (range 1 to 12 months). The lens permitted excellent control of folding and insertion, as well as excellent centration at surgery and 4 months. There was one lens-related intraoperative complication because of crimping of the trailing lens haptic. Postoperative complications were minimal, and 92% of patients achieved a visual acuity of 20/20 or better at 1 and 4 months. Excluding the eyes with retinal pathology, 100% achieved 20/20 or better at 4 months. CONCLUSION: The AMO SI-40NB three-piece silicone IOL with PMMA haptics provided excellent operative control, centration, and visual outcome and is suitable for small incision cataract surgery.

Prospective study of 210 consecutive cases of endocapsular phacoemulsification using the AMO SI-30NB 3-piece foldable lens.

PURPOSE: To assess the acceptability of clinical outcome achieved with use of the SI-30NB lens, as well as the incidence of any lens related complications. METHODS: This prospective study evaluated 210 consecutive eyes undergoing endocapsular phacoemulsification cataract surgery (EPECS), with implantation of the AMO SI-30NB foldable three-piece lens, commencing with the first patient in our practice receiving this implant. There was 99% follow-up for at least three months, with a mean of nine months, and a range of three to 14 months. Incisions were a maximum of 3.2 mm in size, and this allowed minimisation of astigmatism, and maximisation of early visual rehabilitation. RESULTS: The final visual acuity results were excellent, with 95% of cases achieving corrected vision of 6/12 or better. All cases without pre-existing ocular pathology achieved corrected vision of 6/6, apart from a single case which achieved 6/9, but the patient died before follow-up. The lens-related complication rate was less than 1% (two patients). No decentration of any other implant occurred, and no patient complained of edge glare. There were no cases of iris chafing or pigment dispersion. Only three patients (1.4%) required Yag posterior capsulotomy in the first 14 months of the study. Central bag-bag fixation was achieved in 206 of the 210 cases in the study (98%). CONCLUSION: The results achieved using the SI-30NB lens with a small incision phaco procedure were excellent. Lens-related complications occurred in only two cases and very few cases have had problems with posterior capsular opacification.

Prospective evaluation of one surgeon's first 100 cases of endocapsular phacoemulsification cataract surgery.

In this series of one surgeon's first 100 cases of endocapsular phacoemulsification cataract surgery (EPECS), believed to be the first truly prospective study of its kind, 86% of patients achieved corrected vision of 6/6 to 6/4; 96% achieved vision of 6/12 or better; and excluding those with pre-existing pathology, 99% achieved 6/12. Posterior capsular rupture occurred in 11 cases, with vitrectomy being required in eight cases. Detailed analysis of the 100 cases is provided.

Assisted local anaesthesia for cataract surgery (ALACS).

This paper describes an assisted local anaesthetic technique which we have used almost exclusively for extracapsular cataract extraction and posterior chamber intraocular lens implant surgery over the last 12 months. This ALACS technique was developed from a combined neurolept-local anesthetic into an assisted local anaesthetic suitable for day-stay cataract surgery. The technique combines the advantages of purely local (retrobulbar and facial) anaesthesia with the advantages usually inherent in a good general anaesthetic. Thus the patient is in a state of general quiescence and psychic indifference throughout the procedure. ALACS provides excellent and long-lasting akinesia and analgesia, with adequate proptosis of the eye which facilitates surgical access. ALACS is suitable for almost all adult cataract and implant surgery. Our results in 104 cases of ALACS are reviewed in terms of visual results and complications both ocular and anaesthetic; the results appear good and the complications minimal. The results of blood gas estimations done intraoperatively in a small number of patients are also presented, and suggest that the technique is systemically safe.