J Korean Ophthalmol Soc.  2019 Jul;60(7):654-660. 10.3341/jkos.2019.60.7.654.

Comparison of Posterior Capsule Rupture Rate during Phacoemulsification by Novice Ophthalmologists: Microscope vs. Intracameral Illumination

• Kim YJ
• Seo H
• Lee JH
• Kim SW
• Chung TY
• Lee SJ
• Park KH
• Nam DH

• KMID: 2453016
• DOI: http://doi.org/10.3341/jkos.2019.60.7.654

Abstract

PURPOSE
We compared the posterior capsule rupture (PCR) rate between microscope versus intracameral illumination in phacoemulsification surgery performed by novice ophthalmologists.
METHODS
We conducted a retrospective chart review of 300 eyes of 211 patients who underwent phacoemulsification by novice ophthalmologists from March 2012 to October 2017. Novice ophthalmologists (n = 6) were divided into those using microscope illumination (n = 4) and intracameral illumination users (n = 2). The first 50 cataract surgery cases of each novice ophthalmologist were reviewed. The results using a phacoemulsification machine and microscopy were the same. The intraoperative complications and learning curve in each case were evaluated.
RESULTS
Phacoemulsifications performed by novice ophthalmologists showed a statistically significant difference in PCR rate between the microscope illumination (19.0%, 38/200) and intracameral illumination (4.0%, 4/100) groups (p = 0.001). The incidence of PCR was reduced to 22%, 18%, 16%, 12%, and 8% per 10 cases in the microscope group, while it was 15% in the first 10 cases and 0% in 50 cases thereafter in the intracameral illumination group.
CONCLUSIONS
Novice surgeons had a lower PCR rate during cataract surgery using intracameral illumination than using microscope illumination. Both groups showed a tendency for the PCR to decrease with increasing surgical cases, but the intracameral illumination group showed a shorter learning curve.

Keyword

Intracameral illumination; Learning curve; Novice ophthalmologist; Phacoemulsification; Posterior capsule rupture

MeSH Terms

Cataract
Humans
Incidence
Intraoperative Complications
Learning Curve
Lighting*
Microscopy
Phacoemulsification*
Polymerase Chain Reaction
Retrospective Studies
Rupture*
Surgeons

Figure

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  Figure 1 Phacoemulsification learning curve of each illumination. The incidence of posterior capsule rupture was reduced to 22%, 18%, 16%, 12%, and 8% per 10 cases in the microscope group, while 15% in the first 10 cases and 0% in 40 cases thereafter in the intracameral illumination group. PCR = posterior capsule rupture.

• 

  Figure 2 Microscope illumination (A) vs. intracameral illumination (B). In microscope illumination, a red reflex is produced by reflection of bright coaxial light from the macula back to the observer (the ocular of an operating microscope). In Intracameral illumination, on the other hand, a side light of intracameral illumination is shining into not macula but peripheral retina. Therefore, the light reflection from the macula back to the observer is decreased. Furthermore, intracameral illumination improved visibility of the lens and enhanced depth perception of the surgical field.

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