Evaluation of complications of extracapsular cataract extraction performed by trainees

Background: Cataract extraction is the most common intraocular surgery taught to residents. Aim: This study aims to review the complications of trainee-performed extracapsular cataract extraction (ECCE) so as to identify the steps in which the trainee can benefit from closer supervision and practice. Subjects and Methods: This was a descriptive retrospective study of complications in the initial 150 ECCE with intraocular lens implant performed by two Ophthalmologists; from the University of Nigeria Teaching Hospital; Enugu; who visited a high volume training center. Both the intraoperative and early post-operative complications were studied. Data entry and analysis were performed descriptively using the Statiscal Package for the Social Sciences; SPSS version 15.0 (Chicago; IL; USA). Results: The age range of the patients was 40-95 years. The intraoperative complications included capsular flaps 12/161 (7.5); posterior capsule rent; 10/161 (6.2) and vitreous loss; 8/161 (5.0). Corneal complications (striate keratopathy; superior corneal edema; generalized corneal edema and corneal folds) ranked highest in post-operative complications accounting for 34 (56/164). Conclusions: Performance of adequate and proper anterior capsulotomy; minimal handling of the cornea and avoidance of posterior capsular rent are some of the challenges of the trainee in mastering ECCE. Stepwise supervised training can help a trainee master these steps while keeping the complications at acceptably low levels

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial.

Purpose: To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery. Design: Randomized clinical trial. Materials and Methods: This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil ≥ 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil ≥ 6mm at the beginning of the surgery. Results: All the patients achieved pupil ≥ 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil ≥ 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 – P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =.791). There were no complications during surgery or related to the preoperative use of the eye drops. Conclusion: Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.

Final visual outcome following re exploration of cataracts performed by trainee surgeons in India.

Objective: To investigate the outcome of secondary intraocular lens implantation, compare final visual outcome between different categories of surgeon, and evaluate care provided by teaching hospitals to patients with capsular complications. Materials and Methods: Setting: Teaching hospital. Design: Retrospective study. Subjects were recruited by examination of electronic medical records. All patients operated for corrective surgery following capsular complications during cataract surgery were included. All patient medical records were reviewed, and data were collected for 359 eyes. Main outcome measures: Visual acuity and major complications. All collected data were entered into Microsoft Excel and analyzed by SPSS 17 software using cross tabulation and Chi-squared tests. Results: Surgical intervention made a significant difference to the final visual outcome (P < 0.001). The category of the trainee had a significant effect on the final visual outcome (P = 0.021). Conclusion: Capsular complications during cataract surgery should be surgically treated to improve outcome.

[Congenital cataract with pre-existing posterior capsule defect]

To evaluate the diagnostic signs, intraoperative complications and postoperative outcomes in children with congenital cataract and pre-existing posterior capsule defect [PPCD]. This interventional case series was conducted on 14 eyes of 7 patients who underwent lensectomy-anterior vitrectomy for congenital cataract with PPCD. All children had bilateral cataract. Preoperative diagnostic sign of PPCD detected under maximum pupil dilation in patients without a mature cataract included a well-demarcated horizontal oval defect with white margin and scattered white dots around the defect. The greatest lens opacity was over the defect itself. In patients with mature cataract, PPCD was diagnosed during operation. Bimanual irrigation/aspiration and 2-port anterior vitrectomy was performed in all cases. The patients included in 2 girls and 5 boys with mean age of 11.4 +/- 4.1 month. PPCD was diagnosed preoperatively in 5 patients [10 eyes] and intraoperatinely in 2 patients [4 eyes]. Intraocular lens was implanted in 2 eyes of one patient and 12 eyes were left aphakic. Except for nucleus dislocation into the anterior vitreous in our first case which was successfully removed, no other intraoperative complication occurred. During a mean follow up of 21.1 +/- 7.1 month [18-36 month] the visual axis remained clear in all the eyes. Establishing the diagnosis of PPCD preoperatively with fully dilated pupil and careful surgical planning prevents intraoperative complications and produces satisfactory technical results

Complicaciones de la cirugía de la Catarata / Complications of the cataract surgery

Presenta un analisis clínico porcentual de 1,240 ojos, pertenecientes a 715 pacientes operados de cataratas en el servicio de Oftalmología del Hospital l "Hipólito Unanue" de Lima, en un lapso de diez años (1970-1979) con el fin de determinar el tipo y frecuencia de las complicaciones de los mismos y los factores que influyen en su aparición. Se revisa las historias clínicas de los pacientes, tomándose los datos más importantes: edad, sexo (515 hombres y 725 mujeres) y procedencia (en su mayoría de condición socio-económica media y baja), así como un riguroso examen oftalmológico. La mayor incidencia de cirugía fue de catarata senil (74.14%) y en pacientes mayores de 60 años (67.51%). La técnica operatoria fue la extracción intracapsular en el 100% de los casos y sólo accidentalmente se realizó extracción extracapsular, en el 5.16%. La complicación más frecuente, fue la pérdida de cítreo, que conduce a una serie de secuelas, siendo la más grave la queratopatía bullosa y distrofia corneal. La endoftalmitis es una de las complicaciones mas severa, aún con el tratamiento precoz con antibióticos de amplio espectro, que conllevó a la pérdida de la visión y/o del ojo en todos los pacientes que presentaron esta complicación. En la cirugía, la complciación más temida es la hemorrgia, la cual no se puede prever ni controlar y que conlleva pérdida irremediable del ojo