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Outcomes after phacoemulsification surgeries preoperatively categorised according to presumed surgical difficulty

Poster Details

First Author: B.Johansson SWEDEN

Co Author(s):    M. Westerlund   T. Wihlmark   J. Germundsson        

Abstract Details



Purpose:

To analyse outcomes after phacoemulsification surgery in cases preoperatively categorised according to expected surgical difficulty

Setting:

Department of Ophthalmology, Linköping University Hospital, Sweden

Methods:

Planned phacoemulsification surgery cases were preoperatively categorized according to expected surgical difficulty level. Criteria were: Category A: Healthy anterior segment except cataract. Category B: Submaximal pupil dilatation with or without exfoliations, vitrectomized eyes, high hyperopia/myopia, concurrent glaucoma, deep set eye. Category C: Cataract in an eye with contralateral eye blind, previous complicated surgery in other eye, dense white or black cataract, corneal endothelial dystrophy, uncertain cooperation e.g. senile dementia, tremor, small pupil, traumatic cataract, previous corneal transplantation, phacodonesis. 300 surgeries (100 by 3 surgeons each) were examined. Patient age, operation time, Effective Phaco Time and complicated surgical manoeuvres (mechanical pupil dilation, staining of anterior capsule, hooks stabilising capsulorhexis edge, capsular tension ring) were extracted from electronical patient records and analysed.

Results:

121 cases were categorised as A, 132 as B and 47 cases as C. Mean operation times were 11.7 minutes (A), 13.8 minutes (B), and 17 minutes (C) respectively. Surgery time was longer than 20 minutes in 1 of 121 A cases (0.8%), 10 of 132 B cases (7.6%), and 10 of 47 C cases (21.3%). The number of complicated surgical manoeuvres was in group A 2 (0.017 per surgery), in group B 23 (0.17 per surgery), and in group C 28 (0.60 per surgery). In two cases (both B), zonular complication lead to postoperative aphakia.

Conclusions:

Categorising phacoemulsification surgery in three groups according to expected surgical difficulty lead to significant differences between the groups regarding surgery time and number of complicated surgical manoeuvres. This easily implemented approach is therefore helpful when scheduling phacoemulsification surgeries, facilitates optimisation of case mix in operation programmes for surgeons with respect to their different competence levels, and may help to assign adequately competent surgeons to appropriate cases thereby increasing patient safety. FINANCIAL INTEREST: NONE

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