Visual acuity outcomes following vitreous loss in glaucoma and diabetic patients.

PURPOSE: To analyze the visual acuity (VA) of patients with and without vitreous loss, while concurrently analyzing the effects of the pre-existing pathologies of glaucoma and diabetes on VA. METHODS: A retrospective study on 1013 cataract extractions from 1995 to 1999 was performed. Patients included in this study had intraocular lens implantation during phacoemulsification surgery, no intraoperative complications besides vitreous loss, had no other prior ophthalmic condition other than glaucoma or diabetes, and had a postoperative follow-up interval between one and 4 months. When indicated, vitrectomy was performed concurrently with phacoemulsification following vitreous loss. Patients diagnosed with both glaucoma and diabetes were excluded. The identified subjects were then placed into six groups: (1) patients with uncomplicated surgery; (2) patients with surgery complicated by vitreous loss; (3) glaucoma patients with uncomplicated surgery; (4) glaucoma patients with surgery complicated by vitreous loss; (5) diabetic patients with uncomplicated surgery; and (6) diabetic patients with surgery complicated by vitreous loss. A two-tailed, heteroscedastic t-test and power calculation were performed on the preoperative and postoperative visual acuities of the groups. RESULTS: There were statistically significant differences (P < 0.05) in the postoperative VA between patients with and without vitreous loss at the time of surgery. Patients with the pre-surgical conditions of diabetes or glaucoma did not display a statistically significant difference in postoperative VA when compared to controls. However, the pre-surgical condition of glaucoma displayed a trend, which showed it may contribute to a poorer postoperative VA (P = 0.072, power = 0.430). CONCLUSIONS: Vitreous loss is a risk factor for a decreased postoperative VA. Also while the pre-surgical condition of glaucoma may play a role in decreasing postoperative VA, diabetes does not.

Outcomes of temporal clear cornea versus superior scleral tunnel phacoemulsification incisions in a university training program.

BACKGROUND AND OBJECTIVES: To evaluate the complication and visual outcomes of residents performing temporal clear cornea (TCC) compared to superior scleral tunnel (SST) phacoemulsification. PATIENTS AND METHODS: We conducted a retrospective analysis of complications and visual outcomes for 534 phacoemulsification procedures done by third-year residents over a five-year period (June 1992-July 1997) at the department of ophthalmology, University of Chicago. All cases were completed using a TCC or SST incision. RESULTS: There was vitreous loss in 6.0% of 348 eyes with TCC incisions and in 11.8% of 186 eyes with SST incisions (P < 0.02). Posterior capsule breaks occurred in 1 1.5% of the TCC group versus 17.7% in the SST group (P < 0.0453). Best corrected visual acuity of 20/40 or better was achieved in 82.5% of all eyes with TCC incisions and in 75.3% of all eyes with SST incisions (P < 0.05). When 151 patients with previous ophthalmic conditions were excluded, the difference in BCVA between the two groups was not statistically significant. CONCLUSIONS: Most institutions train residents with the SST technique prior to advancing to TCC. This study demonstrates that with proper teaching, residents can achieve excellent outcomes using TCC incisions, and can therefore be trained in this technique concurrently with SST incisions.

Outcomes of extracapsular cataract extraction and phacoemulsification performed in a university training program.

BACKGROUND AND OBJECTIVES: As the number of older Americans increases, more patients will need cataract extraction surgery. Outcome studies will be necessary to assess and improve the quality of care. This study documents the outcomes of extracapsular cataract extraction (ECCE) performed at Oak Forest County Hospital (OFH) and phacoemulsification (PE) performed at the University of Chicago Hospitals (UCH) by residents who were training at the University of Chicago. PATIENTS AND METHODS: Residents train using ECCE during their second year at OFH, and learn PE at the UCH during their third year. The authors performed a chart review of all patients who had undergone ECCE at OFH (N = 52) and all patients who had undergone PE at the UCH (N = 343) from 1995 through 1997. Complete preoperative, intraoperative, and postoperative clinical data were recorded on the American Society of Cataract and Refractive Surgery database. RESULTS: There were no intraoperative complications at OFH, and 23 of 52 (44%) of the eyes had a final best-corrected visual acuity (BCVA) of 20/40 or better. At the UCH, vitreous loss occurred in 16 of 343 (5%) of the PE patients. A final BCVA of 20/40 or better was achieved in 300 of 343 (87%) of the PE eyes. CONCLUSIONS: The visual outcomes of patients who undergo ECCE at a county hospital are poor, but the surgical complications are minimal. The visual outcomes of patients who undergo PE at a university hospital are good, but the complication rates are slightly higher.