First Author: F.Jazayeri UK
Co Author(s): Y. Yang
Purpose:
1. To evaluate the incidence, indications and outcomes in cases of complicated phacoemulsification cataract surgery converted to ECCE.
2. To evaluate whether conversion to ECCE is safer than referral for vitreoretinal intervention when compared to published literature.
Setting:
Retrospective consecutive series of patients undergoing complicated phacoemulsification cataract surgery conversion to ECCE at two sites.
Methods:
Patients were identified from electronic operative records from 1/7/2004 to 4/1/2011. All operations were performed or supervised by surgeons experienced in phacoemulsification and ECCE.
Results:
Twenty-three cases of phacoemulsification underwent unplanned conversion to ECCE. Medical records were not available for two cases. These cases were included for ECCE conversion rates but not other analysis. Follow-up data was incomplete for two further cases. These were excluded for final visual outcome analysis. A total of 35278 cataract operations were performed. The incidence of phacemulsification to ECCE conversion was 0.07%. The reasons for ECCE conversion were posterior capsule rupture (PCR) (7 cases), zonular dialysis (7 cases), combined PCR and zonular dialysis (4 cases), anterior capsule tear (2 cases) and white cataract (1 case). Ten cases (53%) had a gain in vision, four cases had unchanged vision (26%), and five cases had a loss in vision (26%). Four of the five cases with loss in vision were due to complications; postoperative endophthalmitis (final VA NPL), suprachoroidal haemorrhage (final VA NPL), retinal detachment (final VA PL), epithelial ingrowth (final BCVA 6/24). Of the 15 cases in which no pre-existing conditions affected visual function, 46% had VA 6/12 or better, and 20% had final BCVA 6/60 or worse. The group with 6/60 or worse final BCVA were due to: postoperative endophthalmitis (1 case), suprachoroidal haemorrhage (1 case), retinal detachment (1 case).
Conclusions:
Complicated phacoemulsification cataract necessitating intraoperative unplanned ECCE conversion is a rare event and in our consecutive series of 35278 phacoemulsification cataract operations in two sites the incidence of this event was 0.07%.
In our series, where there was no pre-existing condition affecting visual outcome, 46% achieved final BCVA of 6/12 or better. However, 20% in this group achieve 6/60 or worse vision due to complications developing which are likely to be related to the additional risk of ECCE conversion. The results in our study do not compare favourably with the previously published results of Dada et al. and Mercieca et al. This may be due to earlier conversion to ECCE in these studies before substantial complications have occurred. It is also possible that these studies were done earlier in the decade where expertise in ECCE surgery was still prevalent and that this expertise is currently declining with phacoemulsification being the routine method for cataract surgery.
Our visual outcome data also does not compare favourably to published series where cataract extraction was abandoned and referral for further vitreoretinal management was made instead of conversion to ECCE. The British Ophthalmological Surveillance Unit (BOSU) study on the outcomes of pars plana vitrectomy for retained lens material after cataract extraction reported 67% of patients, compared with 46% in our group, achieved BCVA 6/12 or better, and 14%, compared with 20% in our group, achieving BCVA 6/60 or worse.
Our results suggest that in the event of complications developing during routine phacoemulsification cataract surgery where ECCE conversion may be deemed necessary to complete the surgery, it may be advisable to consider not to proceed with ECCE conversion but to terminate the surgery and refer to vitreoretinal colleagues where a vitreoretinal approach can be used to complete the lens fragment removal. FINANCIAL DISCLOSURE?: No
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