Posterior capsular rupture rate and/or vitreous loss rate amongst trainees using a soft tip irrigation aspiration hand piece during cataract surgery

Session Details

Session Title: Moderated Poster Session: Cataract - Complications and Management

Session Date/Time: Sunday 06/09/2015 | 14:00-15:00

Paper Time: 14:40

Venue: Poster Village: Pod 1

First Author: : L.Maubon UK

Co Author(s): :    P. Ursell   C. Igwe           

Abstract Details

Purpose:

Posterior capsular rupture (PCR) rate with vitreous loss (VL) is associated with higher rates of endophthalmitis and retinal detachment. Soft tip irrigation aspiration (I/A) hand pieces have been shown to reduce the risk of PCR during cataract surgery. PCR rate, with or without VL, has been shown to be highest amongst trainee surgeons. We aimed to identify whether cataract surgery performed by trainees using the soft tip I/A hand pieces would reduce the overall PCR rate and rate of rupture occurring during the irrigation stage of soft cortex. This information can be used to influence future teaching practices.

Setting:

Epsom and St Helier NHS teaching hospital, United Kingdom

Methods:

Cataract surgery records for 6 trainees who performed irrigation/ aspiration with a silicone coated 45 degree I/A hand piece between January 2013 and March 2015 were extracted from our electronic database using an auditing tool. For each identified PCR, individual patient records and documentation were scrutinised to clarify at which stage the complication occurred. If there was uncertainty as to which stage of surgery the PCR occurred, video recordings were reviewed and discussions were held with the individual surgeons.

Results:

805 cataracts were performed by the 6 trainees using a silicone coated soft tip I/A hand piece. Trainees were in surgical training years 1-5. Years 1-2 surgical trainees (SHO grades) performed 319 operations and years 3-5 (registrar grades) performed 486 operations. In total there were 13 cases of PCR and/or VL (1.61%). These consisted of 10 PCRs with VL, 2 without and 1 zonule dialysis with VL. PCR occurred most frequently during phacoemulsification (69.2%), followed by capsulorrhexis in (23%) and in one case (7.7%) a small PCR was noted during the irrigation stage.

Conclusions:

Overall our trainees had a low PCR and/or VL rate of 1.61%. This is lower than the national cataract database, which quotes average rates of 1.95% for all surgical grades and 2.5-5% when trainee grades are isolated. We can conclude a significantly lower rate of PCR during the irrigation aspiration stage (7.6%) compared to the range suggested by the literature of 25-30%, despite our relatively small dataset. Soft tip I/A reduces PCR-related complications, which is preferable for patient outcome and safer for teaching trainees. Soft tip I/A is recommended for teaching cataract surgery within our unit.

Financial Interest:

NONE