The evaluation of the risk factors for capsular complications in phacoemulsification


Ergun Ş. B. , Kocamış S. İ. , Çakmak H. B. , ÇAĞIL N.

International Ophthalmology, vol.38, no.5, pp.1851-1861, 2018 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 38 Issue: 5
  • Publication Date: 2018
  • Doi Number: 10.1007/s10792-017-0667-3
  • Title of Journal : International Ophthalmology
  • Page Numbers: pp.1851-1861
  • Keywords: Lens capsule integrity, Phacoemulsification, Posterior capsular rupture, Risk factors, CATARACT-SURGERY, INTRAOPERATIVE COMPLICATIONS, CASE-MIX, OUTCOMES, EYES, RETINOPATHY, RUPTURE, AUDIT

Abstract

© 2017, Springer Science+Business Media B.V.Purpose: To determine and quantify the risk factors for disruption of lens capsule integrity during phacoemulsification. Methods: The medical records of the patients who had undergone phacoemulsification cataract surgery and had a complication associated with lens capsule were reviewed. Consecutive cases were also reviewed in reverse chronological order as a control group. The exclusion criteria were pediatric cataracts, traumatic cataracts and lens dislocation. As a result, 403 uncomplicated and 83 complicated eyes were analyzed. The differences between the complication group and the group without complications regarding the risk factors were shown by employing the Chi-square test and Fischer’s exact test. The variables having the level of significance (p < 0.25) after the Chi-square test and Fischer’s exact test were enrolled into the multiple stepwise logistic regression analysis. Results: Age (60–69/≤80) (p = 0.017), male gender (p = 0.006), pupil size ≤3 mm (p = <0.001), mature–brunescent cataract (p = <0.001), anterior chamber depth <2.5 mm (p = 0.001), posterior polar cataract (p = 0.006), diabetic retinopathy(p = <0.001), coronary artery disease (p = 0.098) and surgeon factor (junior resident/senior resident, p = 0.015; senior resident/specialist in ophthalmology, p = 0.026; junior resident/specialist in ophthalmology, p = 0.020) were among the factors significantly related to a capsule complication. An Excel program has been developed according to these results to predict the probability of capsule complication. Conclusions: Higher-risk cases can be predicted preoperatively, thus allowing surgeons to take appropriate precautions, better informing the patient and better selecting the cases especially for trainee surgeons.