ORIGINAL ARTICLES

Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: incidence and risk factors

S Mahmood¹, H von Lany², M D Cole², S J Charles¹, C R H James², B Foot⁵, P Gouws³ and S Shaw⁴

¹ Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
² Torbay Hospital, Torquay, UK
³ Conquest Hospital, St Leonards-on-Sea, UK
⁴ School of Mathematics and Statistics, University of Plymouth, UK
⁵ The British Ophthalmological Surveillance Unit, The Royal College of Ophthalmologists, London, UK

Correspondence to:
Mr S Mahmood, c/o Mr Charles’ secretary, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH, UK; saj{at}eyebase.co.uk

Aims: To study the epidemiology and risk factors contributing to displacement of nuclear fragments into the vitreous (DNFV) complicating phacoemulsification in the UK.

Methods: Cases were collected prospectively between March 2003 and March 2004 by active surveillance through the British Ophthalmological Surveillance Unit (BOSU). Case–control analysis of risk factors was performed by visiting 10 randomly selected centres using a total of 521 cases of uncomplicated phacoemulsification. Validation analysis to assess under-reporting was performed in a total of 13 randomly selected units.

Results: 610 cases of DNFV were confirmed during the reporting period. The estimated incidence of DNFV was 0.19–0.28%. The group with complications was significantly older than the control group (mean 76.8 vs 74.3 years: p<0.001). Significant preoperative risk factors were posterior synechiae (5.1% vs 2.2%), incomplete pupil dilation (59.5% vs 8.8%), pseudoexfoliation (5.6% vs 1.4%) and previous vitrectomy (7.8% vs 2.2%). Significant operative variables related to surgical experience, topical (14.3% vs 3.1%) and sub-Tenon’s (51.4% vs 37.2%) anaesthesia, and requirement for vision blue (trypan blue ophthalmic solution) (13.7% vs 2.4%).

Conclusions: The estimated incidence of DNFV during phacoemulsification surgery in the UK is two or three per 1000 operations. Risk factors have been identified that should help to guide case selection for phacoemulsification surgery and modify techniques.

Funding: We are grateful for the financial support provided by the following: The British Council for Prevention of Blindness; The Torbay Medical Research Fund; Bausch and Lomb Research Grant.

Competing interests: None declared.

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