Phacoemulsification during the learning curve: Risk/benefit analysis

Abstract

SUMMARYTo assess prospectively the complications and outcomes in a single-surgeon series during the phacoemulsification learning curve a prospective analysis of 400 phacoemulsi fication procedures in 358 patients was carried out. The main outcome measures were capsular tear, vitreous and nuclear loss, best corrected post-operative visual acuity and refractive cylinder. Capsular tears occurred in 6.3%of phacoemulsification procedures, with vitreous loss in 1.5%. One nucleus was lost into the vitreous. Best cor rected visual acuity, including pre-existing pathology, was 6/9 or better in 83.6% of eyes. There was 1 dioptre or less change of astigmatism from pre-operative to 6 weeks in 91 % of eyes. It is concluded that phacoemulsification with careful patient selection can be a safe procedure even during the learning curve.

Vitreous surgery for macular hole-related retinal detachment after phacoemulsification cataract extraction: 10-year retrospective review

“…12,13 Furthermore, most studies have found the overall complication rate with phacoemulsification to be reduced. 14,15 Conversely, the rate of retinal detachment (RD) after cataract surgery has not been reduced significantly by the shift to phacoemulsification. RD is one of the most significant and severe events that can occur after all forms of cataract surgery, including phacoemulsification.…”

O professor e o estudante na facoemulsificação: os dez princípios para o sucesso

“…Cinco desses casos ocorreram em olhos com pupila pequena e dois em olhos com esclerose nuclear de 4+. Após esses estudos, vários outros relataram bons resultados da cirurgia de facoemulsificação realizada por residentes (3)(4)(5)(6)(7)(8)(9) (Tabela1), comparáveis aos de cirurgiões experientes, também no início das suas curvas de aprendizado da facoemulsificação (10)(11)(12)(13) .…”

“…Uma seleção pré-operatória cuidadosa é fundamental para reduzir o índice de complicações no início da curva de aprendizado (2,11,13,34) . O orientador deve fazer parte da seleção pré-operatória dos primeiros pacientes, pois o que é simples para o cirurgião experiente, parece complexo nas mãos do residente, que não consegue prever as dificuldades do procedimento, por falta de experiência prática.…”

“…A incisão limbar ou escleral facilita a conversão para a técnica de EECC, no caso de RCP associada à presença de (5) RCP 3,6% 0,5% PV 2,6% 0% Irvine et al (12) RCP 11% 1,5% Seward et al (11) RCP 7,5% 5% PV 2% 1% Martin, Burton (13) RCP 4,3% 4,3% 1,2% 0,8% PV 4% 3,7% 0,6% 0,7% grande fragmento nuclear intra-ocular e também é mais apropriada para a implantação das LIO rígidas, geralmente as úni-cas disponíveis na maioria dos serviços de residência do país. Muitos cirurgiões que utilizam a anestesia tópica, de rotina, afirmam que a cinesia ocular e palpebral facilita o procedimento cirúrgico, pois permite ao cirurgião orientar o paciente quanto ao posicionamento ocular per-operatório.…”

Quantitative Evaluation of the Learning Process of Phacoemulsification by Senior and Junior Ophthalmologists

“…An objective and qualitative measure of the surgeon's skills are required as there is an increasing need for costeffectiveness for cataract surgery 3). The conventional measures of outcome are complication rates 5-10) , however, only slight changes could be detected when we compared this as a parameter of surgical skills, particularly with a limited number of residents' surgical case since notable surgical complications such as posterior capsular tearing and vitreous loss are less than 5 % in modern phacoemulsification surgery [5][6][7][8][9][10] . In addition, even with the same surgical technique, numerous factors other than surgeon's skills are involved in the evaluation, e.g., local and systemic patient conditions, instrumentation, assistants, and other factors.…”