Microsoft Word - Ibrar Ali.doc 64 Original Article Phacoemulsification: Complications in First 300 Cases Abrar Ali, Tabassum Ahmed, Tahir Ahmed Pak J Ophthalmol 2007, Vol. 23 No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . See end of article for authors affiliations …..……………………….. Correspondence to: Dr. Abrar Ali 1-D-1/2, Nazimabad, Karachi. Received for publication August’ 2006 …..……………………….. Purpose: To find out complications of phacoemulsification in our first 300 cases. Material and Methods: Retrospective analysis of our first 300 cases of phacoemulsification was done. Operations were performed in different hospitals of city. After thorough examination and investigations, patients were operated. Most were operated under retrobulbar anaesthesia. First examination was on first post operative day and then followed up after one week, three weeks and eight weeks. Their operative and postoperative complications were analysed. Results: Posterior capsular rupture was the most common intraoperative complication in our initial cases. Corneal edema on first postoperative day was significant problem and because of this vision on first post operative day was low in most of our initial cases. After three weeks the vision was 6/12 or better in 83% of cases. Conclusion: Complications rate in initial learning curve was higher, which was dissatisfying for both surgeon and patients. Better outcome was achieved with more experience and adopting better techniques. n the era of modern cataract surgery phacoemul- sification is most demanding procedure by cataract patients and similarly patients’ expectations are also high about the out come. To stay in practice it is becoming essential to learn the art and science of phacoemulsification as once stated by Durrani J “We must not succumb to inertia and stay static or else the world will pass us by”1. In this study we retrospectively evaluated our first 300 cases of phacoemulsification to find out various complications. METHODS AND PATIENTS We started after proper wet lab. Operations were done in different hospitals of the city on company and private patients. Phacoemulsifications done in free eye camps are not included in this study. Complete thorough eye examination was done. Routine laboratory investigations were done. In all patients I/V cannula was passed before operation. After all aseptic precautions operation was started. In majority of patients retrobulbar anaesthesia was given. Facial block was given in 15.7% of cases (Table 1). Superior rectus suture was given in 34% of cases. Pupils were dilated with tropicamide 1% and phenylephrine 10% eye drops. Three step tunnel incision was given at about 11 O’ clock position with 3.2 mm keratome. Anterior chamber was filled with methylcellulose 2%. Capsulorhexis was done in all cases by bent 27G needle. Capsulorhexis was not central and circular in few cases. Side port was made with 15 degree knife and in few cases with No.11 knife. Peritomy was done at incision site. Hydrodisection was done in 99% of cases and in few cases especially with posterior subcapsular cataract hydrodelineation was also done. I 65 Bimanual phacoemulsification technique was used in all cases. Machine parameters were set at two memories. At first setting phaco power was 70%, vacuum at 30mm of Hg and flow rate at 25mm, after sculpting and nucleus division, vacuum was changed to 70mmHg keeping same phaco power and flow rate. The remaining lens matter was removed and aspirated by Simco I/A cannula. The anterior chamber and bag were refilled with methylecellulose 2%. The incision was enlarged by 5.2 or 5.5 mm keratome. In few cases the enlargement was done by No 11 knife. In about 85% cases phaco PMMA intraocular lens (IOL) were implanted in the bag. In few patients we were not sure about position of superior haptic whether it was in or out of bag. Where there was large posterior capsular break, larger optic IOL was implanted in the sulcus. In few patient miosis was achieved by intracameral injection of miotics. One or two 10/0 nylon sutures were given at phaco port in 75% of cases. Subconjunctival antibiotic gentamycin 40 mg and steroid dexamethasone 2 mg injections were given. These injections were not given in topically anaesthetized patients. No pad and dressing was done in topically anaesthetized patients after operation. Patients were followed in OPD on next day, after one week and then after four weeks and two months. Average follow up was of 2 years. RESULTS Patients were operated in different hospitals of city. On first post operative day the vision was less than 6/60 in majority of patients (Table 2) and was 6/12 and better in majority of patients (Table 3) after three weeks. The complications were analysed as occurred during operation (Table 4) and those faced after the operation (Table 5). The commonest intraoperative complication was posterior capsular rupture. Corneal edema was present in 61.7% of cases, which was the main cause for reduced vision on first post operative day. DISCUSSION Surgeons’ main concern is minimal operative and post operative complications. The complications correlate themselves with the surgeon experience2. We faced problems in the initial phase of conversion to the phacoemulsification till we became experienced in that procedure. In this study we have analysed our complications in phacoemulsification cases. Anaesthesia Retrobulbar anaesthesia was the commonest technique for this procedure we adopted. In few cases the experience of topical technique was very bad. In only 16% of cases facial block was given and there was no problem without facial block. Post operative Vision The main concern of the patient is their vision in first few days after operation. Other wish of patients is to have 6/6 vision without glasses. In our initial cases this patients’ concern was very upsetting as vision was not good in first few days postoperatively. (Table 2). The main reason was corneal edema and striate keratopathy in early post operative period. As the cornea cleared the vision improved in majority of the cases (Table 2) which is comparable to the other studies3,4. Table 1: Type of anaesthesia Type No of cases n (%) Peribulbar 75 (25) Retrobulbar 179 (45) Topical 46 (30) Total 300 (100) Facial block 47 (15.67) Table 2: Vision on 1st postoperative day Snellen’s vision No of cases n (%) 6/12-6/6 53 (17.67) 6/60-6/18 83 (27.67) CF-6/60 159 (53)