The Melaka Hospital cataract complications study analysis of 12,992 eyes

Abstract

Introduction:As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations.Materials and Methods:The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20.Results:Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes.Conclusion:Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication.

Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications

“…Contemporary phacoemulsification has an extremely high level of safety and success, but as previously noted complications still occur in around 5% of cases in teaching hospital series . Preoperative risk stratification systems are effective in identifying cases at higher risk of such intraoperative complications .…”

When is a complication a complication in contemporary cataract surgery?

“…Analysis of the published literature over the last 5 years reveals some trends in the contemporary reporting of adverse outcomes in cataract surgery. In this period, of 69 cataract surgery‐related studies published in English language journals, only 11 large studies (with ≥500 participants) reported comprehensive outcomes in terms of commonly reported intraoperative and/or postoperative complications …”

“…Intraoperative complications that were commonly described in 10 large studies included: capsular tears, dropped or retained nucleus fragment, choroidal, suprachoroidal or vitreous haemorrhage, zonular dehiscence, IOL issues (including IOL drop and exchange) and vitreous loss . However, only two (20%) of these studies reported all six of the most common intraoperative complications: posterior capsular rupture, dropped or retained nucleus fragment, vitreous loss, zonular dehiscence, IOL issues and haemorrhage.…”

“…[7][8][9][10][11][12][13][14][15][16][17] Intraoperative complications that were commonly described in 10 large studies included: capsular tears, dropped or retained nucleus fragment, choroidal, suprachoroidal or vitreous haemorrhage, zonular dehiscence, IOL issues (including IOL drop and exchange) and vitreous loss. [7][8][9][10][11][12][13][14][15][16] However, only two (20%) of these studies 7,12 reported all six of the most common intraoperative complications: posterior capsular rupture, dropped or retained nucleus fragment, vitreous loss, zonular dehiscence, IOL issues and haemorrhage. Less frequently described complications included: central corneal oedema, corneal epithelial abrasion, Descemet's membrane detachment, endothelial trauma, acute intraoperative hypertension, iris herniation or trauma, incision or phaco burn, hyphaema and 'wound problems'.…”

“…The commonly discussed postoperative complications in eight large studies included: endophthalmitis, retinal detachment, cystoid macular oedema, persistent corneal oedema, raised intraocular pressure and IOL displacement or dislocation. [7][8][9][10][11][12]14,17 Similarly in respect to intraoperative complications, only two (25%) studies 8,10 actually reported all six of the most common postoperative complications. Other less frequently described complications included: wound dehiscence, posterior capsular opacification, hypotony with choroidal effusion, vitreous haemorrhage, hyphaema, choroidal detachment, retention of crystalline lens fragments, toxic anterior segment syndrome, vitreous wick syndrome and 'abnormal incision'.…”