Outcomes After Phacoemulsification Surgeries Preoperatively Categorized According to Presumed Surgical Difficulty
Purpose
To analyze outcomes after phacoemulsification surgery in cases preoperatively categorized after expected surgical difficulty.
Methods
Planned phacoemulsification surgeries were preoperatively categorized according to expected surgical difficult: 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 - 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 maneuvers were extracted from electronic patient records and analyzed.
Results
A total of 121 cases were categorized 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 maneuvers 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.
Conclusion
Categorizing cataract surgery in 3 groups according to expected surgical difficulty gave significant differences between groups regarding surgery time and number of complicated surgical maneuvers. It facilitates optimization of case mix, and helps assigning adequately competent surgeons to appropriate cases thereby increasing patient safety.