The phacoemulsification learning curve: per-operative complications in the first 3000 cases of an experienced surgeon
The phacoemulsification learning curve: per-operative complications in the first 3000 cases of an experienced surgeon
复制标题
DOI：
10.1038/eye.2000.52
复制
发表时间：
2000-04-01
期刊：
影响因子：
3.9
通讯作者：
Burton, RL
中科院分区：
文献类型：
--
作者：
Martin, KRG;Burton, RL
目的探讨由经验丰富的外科顾问医师进行的3000例超声乳化术的术后并发症。方法对1992年11月至1998年11月连续3000例无监护病例进行前瞻性分析。每个病例记录的资料包括术前并发症、术前最佳矫正视力、核密度、既往玻璃体部切除术史以及是否将超声乳化术作为超声小梁切除术的一部分。结果玻璃体丢失率为1.3%。6例（0.2%）核碎片丢失于玻璃体。最初的300例玻璃体丢失率为4.0%，在最后300例中下降到0.7%。撕囊失败是最常见的术后并发症，但后囊膜破裂的风险从前100例的45例中的9例（20.0%）显著下降到后2000例的49例中的1例（2.0%）（p = 0.0061， Fisher精确检验）。致密白内障的风险显著增加，尤其是撕囊失败，在最致密的病例中，风险上升到35%以上。后囊破裂和玻璃体丢失的增加不那么明显，但仍然非常重要。白内障小梁切除术术后并发症的风险没有显著增加，以前接受过玻璃体切割手术的患者的风险也没有增加。612例局部麻醉中有22例（3.6%）发生后囊破裂，而2269例表面麻醉中有31例（1.4%）发生后囊破裂。术后最佳矫正视力达到6/9及以上的前1000例为2.0%，后1000例为13.9%。结论(1)术中手术风险在学习曲线期间可以降低到较低水平，但并发症的发生率仍然较低。(2)既往玻璃体切除眼的手术并发症风险无明显升高。(3)核密度与术前并发症风险显著相关。(4)白内障手术的视力阈值随着超声乳化手术经验的增加而急剧下降。(5)局部麻醉与术后并发症风险增加无关。
Purpose To assess the per-operative complications occurring during the first 3000 phacoemulsification cases performed by an experienced consultant surgeon.Methods A prospective analysis of 3000 consecutive cases performed without supervision between November 1992 and November 1998 was carried out. Data recorded for each case included details of per-operative complications, pre-operative best corrected visual acuity, nuclear density, history of previous pars plana vitrectomy, and whether phacoemulsification was performed as part of a phacotrabeculectomy procedure.Results The overall rate of vitreous loss was 1.3%. Nuclear fragments were lost to the vitreous in 6 cases (0.2%). The initial rate of vitreous loss was 4.0% in the first 300 cases falling to 0.7% in the last 300 cases. Capsulorhexis failure was the commonest per-operative complication observed, but the risk of subsequent posterior capsule rupture fell significantly from 9 of 45 (20.0%) in the first 100 cases to 1 of 49 (2.0%) in the next 2000 cases (p = 0.0061, Fisher's exact test). There was a significant increase in risk with denser cataracts, especially for capsulorhexis failure, rising to over 35% in the densest cases. The increases in posterior capsule rupture and vitreous loss were less dramatic but nonetheless very significant. There was no significant increase in the risk of per-operative complications with phacotrabeculectomy, and no increased risk in patients who had previously undergone pars plana vitrectomy. Posterior capsule rupture occurred in 22 of 612 (3.6%) local anaesthesia cases compared with 31 of 2269 (1.4%) topical anaesthesia cases. Peroperative best corrected visual acuity of 6/9 or better was recorded in 2.0% of the first 1000 cases compared with 13.9% of the last 1000 cases.Conclusions (1) Per-operative surgical risks could be reduced to low levels during the learning curve, but complications continued to occur at a low frequency. (2) The risk of peroperative complications was not significantly elevated in previously vitrectomised eyes. (3) Nuclear density correlated significantly with per-operative complication risk. (4) The visual threshold for cataract surgery fell dramatically with increasing experience of phacoemulsification. (5) Topical anaesthesia was not associated with an increased risk of per-operative complications.