Clinical Results of Posterior Capsule Ruptures in the First 1000 Phacoemulsification Cases

ABSTRACT

PURPOSE: To analyze the results of posterior capsule rupture (PCR) that occurred in the first 1000 cases performed by a newly trained phacoemulsification surgeon. METHODS: The medical records of 47 eyes of 45 patients who suffered PCR among the first 1000 cases of cataract surgery performed by one newly trained surgeon were reviewed. All surgeries started with the plan of phacoemulsification and there was no supervision by any experienced surgeon. RESULTS: Over the course of the series of 1000 cases, the PCR incidence rate steadily fell from 12% in the first 100 cases to 4.7% (47 cases) for all 1000 cases as the operator gained experience with the techniques. However, after the change of phaco machine and the technique of nucleus removal, the incidence increased abruptly to 11% and then decreased again. There was no significant difference in PCR incidence between surgeries of the first eye and the second eye of the 335 patients who underwent cataract surgery in both eyes by the surgeon (p=0.534). PCR occurred most commonly in the course of phacoemulsification (83.0%) and mainly in the eyes with severe nucleus sclerosis. CONCLUSIONS: In the early stages of the career of a phacoemulsification surgeon, the PCR incidence showed a learning curve that decreased with increasing experiences, then it increased again after the change of operational procedure before finally decreasing once more. In the surgery of the second eye, poor patient cooperation could be overcome with a careful approach, and PCR occurred most commonly in the course of phacoemulsification (83.0%).