By Ana Hidalgo-Simon, MD, Ph.D.

BRUSSELS- A new survey of Dutch eye surgeons shows that they nearly all rely on phacoemulsification, while 62% still prefer to use retrobulbar anaesthesia. Compared to an earlier survey carried out in 1999, there has been an increase in the use of foldable and multifocal IOLs while LASIK is emerging as the refractive procedure of choice, according to Ype Henry, MD, Department of Ophthalmology, Academic Hospital Vrije University, Amsterdam, The Netherlands.

The current survey was based on the results of a questionnaire sent to 380 practicing eye surgeons of whom 721% completed the questionnaire. Among other things it showed that most of the respondents perform between 16 and 50 cataract operations a month, a slight increase from the 1999 survey. The preferred anaesthetic technique for 62% of the surgeons was retrobulbar in 2000 compared to 68% in 1999. Other methods such as sub-tenon (17%) and topical (11%), whereas general anaesthesia was used only infrequently, the Dutch survey showed.

Corneoscleral Incisions On Increase
Along with a growing preference for phacoemulsification, an increasing percentage of respondents in the 2000 survey (43%) said that they preferred to use a corneoscleral incision, while there was also a noticeable increase in the use of corneal incisions, and a decrease in the number of surgeons who use straight, frown or parallel incisions, The location of the incision is still very conventional, with a clear preference for the superior incision, mainly at 12 o'clock, while most surgeons (71%) either never or very rarely (1-10%) perform clear corneal incision., Dr. Henry pointed out.

Healon Still Viscoelastic of Choice
The market leader in viscoelastics in the Netherlands has traditionally been Healon. Although it has experienced a slight decrease of around 10% in the last couple of years, it is still used by nearly 47% of surgeons. Other preferred viscoelastic substances also included other sodium hyaluronate products.

Regarding preferred nucleofractis technique, the classic "divide-and-conquer" in 4 parts is the most widely used with more than 88% of the year 2000 survey respondents saying they favoured that procedure. Other sophisticated methods such as stop and chop and sculpting techniques are not very commonly used, the survey showed.

IOL Preferences are Changing
The standard IOL used in 2000 was still PMMA (42%), although its popularity is decreasing. However, the use of both silicon (31%) and acrylic (21%) IOLs is on the rise. Otherwise, foldable lenses are now used by more than 50% of the 2000 respondents and the most popular optic size for phacoemulsification implantation was 5.5 mm (48%), followed the 6mm (30%), which appears to be gaining in popularity.

Dr. Henry pointed out that the use of the tunnel suture after phacoemulsification is decreasing, probably due to the fact that foldable lenses allow for a smaller incision and less sutures are required. Over 65% of surgeons regularly perform suture-less surgery, compared with 48% in 1998.

Dropped Nucleus and Other Complications
The survey also indicated showed that the dropped nucleus, was defined as more that one quarter of lens material in the vitreous cavity was about 1.6 per 1000 cataract surgeries, The number of reported cases of endophthalmitis was also 1.6 per 1000 cataract operations, which was very similar to the 1999 rate.

The Changing Refractive Surgery Picture
In 1999, 85,000 cataract operations were performed in The Netherlands, a number very similar to the year before, with 21% of the respondees saying they would begin doing refractive surgery in the next three years. Although PRK was the leading technique in last year's survey, it had declined somewhat compared to earlier surveys, while LASIK was on the increase. There was also a small but growing acceptance of phakic IOLs. However, when asked if they have plans to start performing refractive surgery in the next 3 years, only 21% of the respondents said yes, Dr. Henry noted.