CATARACT SURGERY SAFETY

The risk of posterior capsule (PC) rupture during irrigation and aspiration (I/A) is decreased with the use of a silicone tip instrument, a new analysis indicates. The study was conducted by ophthalmologists at the MidYorkshire Hospitals NHS Trust, UK, where in September 2011, the department switched from using a metal tip I/A instrument to a silicone tip device (CapsuleGuard, Bausch + Lomb Storz). It was reported by Atul Varma FRCOphth, MS, consultant ophthalmologist, at the XXXI ESCRS Congress in Amsterdam.

Information on intraoperative complications was extracted from patient electronic records for all procedures performed during a four-year period beginning two years prior to the introduction of the silicone tip I/A instrument and ending two years after the change. All procedures were performed using either the Millennium or Stellaris phacoemulsification units (Bausch + Lomb). About 10 per cent of cases during both periods were performed by trainees.

Complications occurred in 159 (3.4 per cent) of 4,754 eyes operated on during the first two years of the study period using the metal tip I/A instrument and in 192 (4.1 per cent) of 4,681 eyes operated on using the silicone instrument during the last two years. PC rupture (with or without vitreous loss) or zonular dialysis occurred in 96 cases performed with the metal tip I/A instrument (2.0 per cent) and in 87 cases (1.9 per cent) of the silicone tip I/A series. While the vast majority of the capsule rupture/zonular dialysis complications in both study groups occurred during phacoemulsification, 16 (16.6 per cent) of the 96 events in the metal tip I/A group but only one (1.14 per cent) of the 87 cases in the silicone I/A tip series occurred during I/A, reported Dr Varma.

“The UK Cataract National Database Electronic Patient Record systems audit of 55,567 cataract operations performed by 406 surgeons from 12 NHS Trusts found posterior capsule rupture and/or vitreous loss occurred in 1.92 per cent of eyes. I/A was one of the steps where a number of the posterior capsule ruptures occurred, and the rate of posterior capsule rupture for cases performed by trainees was up to 16 per cent,” said Dr Varma.

“Our study found a dramatic reduction in the rate of this complication during I/A after switching to the silicone tip device, and our findings are consistent with data reported by other investigators. Similar results as ours were also reported by Blomquist and Plienneke in 2005 published in JCRS and also had similar reduction in PC rupture rates. Therefore, we believe it should be the I/A handle of choice, especially when training young ophthalmologists.”

Dr Varma also presented a video to demonstrate the safety of I/A, cortex removal and capsule polishing using the silicone tip I/A handpiece. “The only precaution is that surgeons must take care in correctly aligning the silicone tip so that no part of the straight metal portion of the handpiece is visible in the curved region of the silicone tip,” he said.